Recently I packed my desk for a temporary move while our office undergoes a phased renovation when I came across some mementos of my many years as a healthcare architect. Buried deep in a drawer, I found my first hospital identification badge from 20 years ago, complete with my name and the facility name, but no picture and no security clearance. I’d like to say how much things have changed, but have they really?

In my opinion, not only as an architect, but as a patient or visitor as well, I want the facility to know who is in the building to visit an inpatient. Especially now, with the increasing prevalence of all-private rooms, inpatients may find themselves with even less of a sense of security than with shared rooms. Why not be proactive rather than reactive?

In my recent experience, I entered a hospital as a visitor through one of the many access points, I was not stopped or greeted by the person at the information desk (which was vacant on my subsequent weekend visit), I headed directly up to my family member’s room, rounded the corner of the nurses’ station, passed several people on the way, and was never stopped. It is more difficult to access the Department of Public Health in Connecticut than it was to reach my loved one who was sleeping at the time and unaware of my entry into his room. I would have preferred to have been stopped and know that anyone roaming the halls of the hospital would have been stopped as well.

Today, my hospital badges typically include a photo, my name, my company, as well as a swipe card for security clearance. However, some facilities I work with on a regular basis issue no badge at all. Although, at those facilities, a general visitor is not required to have additional identification either, some healthcare facilities require all visitors to sign in, often issuing a sticker badge with the date stamped on it. Other hospitals use paper passes or some type of visitor badge, particularly if you are visiting a patient floor.

Policies vary from institution to institution and are often dependent on their physical locations. For instance, an urban tertiary care center may have stricter policies than a community hospital. I recall one urban facility during the 1990s that used glass cases in the main lobby to prominently display the different types of unallowable weapons that people attempted to bring through the metal detector and into the facility, intentionally or not.

The most stringent security measures throughout the years have focused on such units as maternity, infant care, and behavioral health. Emphasis has also been on the Emergency Department, not only for the vulnerability of the circumstances that brought patients in but because it is the one door that remains open 24 hours a day, seven days a week, 365 days a year. A recent poll on the HEALTHCARE DESIGN blog about hospital security indicated that 40% of those polled felt that access should be completely open, 16% felt visitors should have to sign in only, and 44% felt that visitor ID badges and X-ray security gates at critical points are important. I agree that ID badges need to be distributed, and visitors must be tracked by security for the safety of patients, staff, and visitors.

Kathy Bell, AIA, ACHA, is Associate at The S/L/A/M Collaborative and specializes in master planning, programming, planning and design within the healthcare sector. She has a special focus on issues and innovations regarding patient safety in emergency department and patient care units.