Our policy is two visitors per patient. We just have stickers that are issued at our front desk and the desk staff is supposed to call back to the pod and ask when the visitors can go back. Most of the time, the desk folks know to give at least 20 minutes for us to get the patient off the EMS stretcher and at least initially checked in and settled before sending a visitor back. There are exceptions, of course, like when we have a patient that has AMS, etc. We can also put notes in our message column of our patient track / software to communicate "NO family" or "send family," or the like. We also have a badge entry door into the main part of the ED but that can be dodged if we don't catch the visitors right away. From the desk, we can push a button to release the doors but when it is crowded, we miss people.
When we have patients that are close to end of life, we can accommodate more people but those patients are generally in a larger room anyway. We are so fortunate to have a Family Rep that helps the docs and nurses herd the masses. We have several small waiting rooms within the department where we can place extra visitors too.
We also don't allow young kids in the back but we are an adult ER. Kids are just too much liability in the back and aren't usually very well behaved either. I know there are times when that is the only option but when 15 people show up, there really is no need for the littlest kids to be in the ER. We had one patient who was basically there for a broken wrist and about 25 people showed up to the ER with about 8 kids in tow. It is great for someone to be that loved and cared for but it was totally overwhelming to the staff to have to manage that crowd and they took up about half of the waiting room with an already crowded lobby of REALLY sick people.
Our security is also pretty responsive when we have people dodge the doors or congregate in the halls, etc. They are a great help when too many people start showing up. If they don't want to leave, security can escort them out to the lobby. Our hospital policy actually reads that visitors that are disruptive to patient care can be removed but we, luckily, don't have to enforce that too much. So, while we have the two visitor rule, we don't post this anywhere because visitors will then say "I have a right to go back there..." when really they don't.
Oh.... in our initial intake of the patient we do try to tell them of or policy and ask if he/she wants to designate a support person. Sometimes, the patients help police the policy but there are times we have to enforce it too. My go-to line is, "I now you all want to visit Joe but our rooms are so small and we do have a two person visitor policy. You are welcome to swap out visitor stickers in the lobby so you can all have time to visit." It does help that we have two chairs in each room and folks don't like to stand for too long.
What I cannot stand is when the visitors hover around both sides of the bed. I'm like, "how am I supposed to tend to your patient from way back here?" I try to put the chairs on the side of the room where the family can sit and say something like, "y'all can have a seat in one of those red chairs..." in my stickiest Southern drawl.
People kill me. I know they want to BE with the patient but you gotta let us do our jobs.