Reader Question

It’s risky to allow patients to leave by the back door

Question: We have a physical therapy clinic that has an exit leading directly from the treatment area to the patient parking lot. Since most patients don’t need to check out at the front desk before leaving, the therapists often direct them to this rear exit for convenience. But I’m concerned that patients are leaving through a door not specifically intended for the general public to use. Am I right to be concerned or am I overreacting?

Answer: You’re not overreacting. To the contrary, you’re being a good risk manager, says Fred Roll, president of the International Association for Healthcare Security and Safety in Glendale Heights, IL.

A "back door" or any door not within sight of your staff and intended for the public to use always poses a risk, he states. When people are allowed to come and go through that door, you raise the risk of theft for starters. If the door is unlocked and anyone can slip in unnoticed, you’re going to find some laptops missing before long. And even if the door is locked from the outside, it’s easy enough for someone to slip in when a patient comes out, Roll adds.

"Not only do they get in to do the theft, but then they get right back out that same door no one is watching. There’s no one to ask why they’re carrying your computer away," he says. "It’s the same reason we don’t let environmental service people park in the loading dock of a hospital after hours. They can just walk out the door and throw something in the truck and take off."

Of course, theft is not the worst result. The same person could enter to assault an employee or patient, and then the risk manager is going to have to explain why a rapist so easily slipped into the facility.

Allowing patients to use more than one main exit door also stretches your security resources. In many cases, your security resources are simply the front desk staff. They’re expected to keep an eye on the lobby and notice if something is wrong. "But they can’t watch the other doors, too, and I’m guessing your physical therapists are involved with patients so they’re not watching the back door," Roll says. "If you have limited security resources, you structure things so that they can keep their attention on one area."

Roll says it is proactive to recognize the risk of letting patients leave from multiple exits. It is not necessary to have patients check out at the front desk, but he suggests funneling them back through the same door they entered. "It might be something that poses a small inconvenience, but you’re preventing something much worse," he says.