What is the one thing you could do to help your loved one recover and get out of hospital faster?
Make friends with the nurses? Give the consultant a bottle of wine? Make a fuss, complain about everything?
Some or none of these things might work — though there’s no guarantee it will get your loved one home quicker.
But from what I’ve seen in practice and based on research, there is one really simple but effective step that will make a difference: basically move in with them — visit them as much as you can, take in food for them, help them to eat and drink, and just be there for as long as you are allowed.
As part of my training as an A&E consultant, I spent a year working on medical wards looking after elderly patients. The memory of one woman stands out clearly, because her husband was able to do all this for her. And when he couldn’t because of restricted visiting hours, it effectively killed her.
Visit your loved one as much as you can, take in food for them, help them to eat and drink, and just be there for as long as you are allowed
This patient was an amazing woman — she had dementia but was so happy, always singing and encouraging the staff and other patients to join in with songs.
She was admitted for confusion following a urine infection. Due to her frailty, we had expected her to die within a few days. But for the first couple of weeks, she did surprisingly well. It wasn’t anything we as doctors or the nurses did, but what her husband did for her.
Every day, he sat beside her and fed her and helped her to drink. He brought in beautifully prepared, nutritious home-made food — in stark contrast to the hospital-provided, ultra-processed excuse for a dinner that stood on the tray at the bottom of her hospital bed, untouched because of the lack of staff to feed her.
After a couple of days he asked if we could heat up the food he was giving her. Of course we did, knowing the benefits of him helping to feed her were greater than any risks that his food might carry simply because there was no use-by date on it.
With his constant care, she started to improve. So much so that she could start to get out of bed — he helped her to the commode and then, when she had strength, he walked her to the loo.
As the staff saw how invaluable he was to her care, the restrictive visiting hours from 2pm to 8pm were lifted for them. This meant he could help her get to the loo before bed and kiss her good night.
The day before she was due to be discharged there was a new senior nurse on the ward, who insisted he stick to the rigid visiting times. Saddened, but too timid to argue, he left.
He got a call a few hours later. His wife had tried to get herself to the loo; the nurses told her to wait a couple of minutes for them to take her. But as they were short-staffed, this wait became an hour.
Desperate and also too proud to allow herself to have an accident in her bed, she tried to walk there by herself. But she slipped and broke her hip. Although operated on the next day, she never left hospital and died three weeks later.
Restrictive visiting times was never put on the death certificate, but in my view it was certainly a significant contributory factor.
I think you should be able to visit your loved one without restriction (up to a certain point at night, obviously, as they — and you — need to sleep).
If the patient is happy, and the visitors have no adverse impact on their care or on other patients, then there should be unrestricted visiting when patients are awake, writes Professor Rob Galloway
But as we know outside of A&E, maternity and children’s wards, most hospitals have standard visiting times of 2pm to 8pm; the rationale being two-fold — firstly to stop the spread of infections and, secondly, because the ward rounds and nursing care rounds are in the morning, and the idea is that visiting then would delay the doctors and nurses in their work.
But this rationale is irrational, and many hospitals are coming to realise this.
The latest to change was the Leicestershire Partnership NHS Trust, which runs a number of community hospitals. Last month it expanded its visiting times of 2pm-8pm to 11am-8pm.
Its executive director of nursing, Anne Scott, said: ‘We recognise the value that visiting makes to the health, wellbeing and care of our patients and service-users.’
For just because that’s the way things have always been, doesn’t mean it’s right or based on evidence of what’s in the patient’s best interest.
On the contrary, there have been many studies showing that liberalising visiting times so loved ones can freely come and go improves patient outcomes, reduces length of stay and saves money; a win-win for all.
How does this work? Having less restrictive visiting times reduces patients’ stress levels. A review of studies published last year in the journal PLOS One, showed that as patients’ stress levels decrease — which extended visiting times play a part in — so their outcomes improve. This was the case for both how patients felt — reducing symptoms such as pain — and more objective indicators, such as length of stay in hospital.
Another review, published in the journal Critical Care, found that unrestricted visiting in intensive care led to both a significant reduction in length of stay — by one day — as well as a 60 per cent reduction in delirium in all patients. Crucially, there was no increase in infections.
The attention — and also the food — are important, too. We all know the awful impact visiting restrictions had during Covid, but one key aspect was highlighted in a 2021 study in the International Journal of Nursing Studies. Among the negative consequences for the patient’s health, was that many not only ate less, but did less physically — such as taking themselves to the bathroom.
This was in addition to the mental health consequences including depressive symptoms, agitation and reduced cognitive ability. The nutritional aspects of this study were alarming, and it’s because it’s often visitors helping their loved one to eat that stops malnutrition.
As reported in the Journal of Human Nutrition and Dietetics in 2022, one third of patients who enter hospitals well-nourished can leave malnourished. It’s far too often the case that staff rushed off their feet leave food out of the reach of patients and don’t have the time to help feed those who are not able to feed themselves, let alone open their drink and yoghurt cartons.
Finally, there is a strong argument for having relatives present on both the ward and drug rounds — when nurses give out the medications to patients.
Being there they can answer questions from the clinicians to help plan care, and relatives also have their questions answered, reducing their anxiety.
It may make the ward round slightly longer, but the benefits far outweigh the extra time needed. In addition, relatives can be the final check for their loved ones in terms of reducing medical errors — for example, checking that they do not get a drug they are allergic to.
And having relatives around more may make everyone up their game, knowing they are being watched. A 2006 study, published in the journal Infection Control and Hospital Epidemiology, showed that in five German intensive care units, if staff knew they were being watched, their compliance with hand-washing rules increased by 55 per cent.
Rules may be rules, but if they make no sense, then for the sake of your loved ones, please challenge them.
In my view, if the patient is happy, and the visitors have no adverse impact on their care or on other patients, then there should be unrestricted visiting when patients are awake.
I’ve seen the benefit of that. A week ago, my wife gave birth to our daughter; the ward was amazing in the care they provided, but also let me visit the whole time.
It was important for me, took some pressure off the staff and crucially helped my wife and our new baby.
But this ability to visit should be standard for all patients on all wards.
Ultimately, it’s your loved one in hospital and it’s you, above all else, who needs to advocate for them.
That way you can be there for them when they need you the most.
@drrobgalloway