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2.
J Public Health Manag Pract ; 28(1): E299-E306, 2022.
Article in English | MEDLINE | ID: covidwho-1526218

ABSTRACT

OBJECTIVE: In response to the COVID-19 pandemic, hospitals have developed visitor restriction policies in order to mitigate spread of infection. We reviewed hospital visitor restriction policies for consistency and to develop recommendations to highlight fair and transparent restrictions, exceptions, and appeals in policy development and implementation. DESIGN: Collection and analysis of public-facing visitor restriction policies during the first 3 months of the pandemic. SETTING: General acute care hospitals representing 23 states across all 4 major regions of the United States. PARTICIPANTS: A cohort of the 70 largest hospitals by total bed capacity. MEASUREMENTS: Characteristics of visitor restriction policies including general visitor restriction statement, changes/updates to policies over time, exceptions to policies, and restrictions specific to COVID-19-positive patients. RESULTS: Sixty-five of the 70 hospitals reviewed had public-facing visitor restriction policies. Forty-nine of these 65 policies had general "no-visitor" statements, whereas 16 allowed at least 1 visitor to accompany all patients. Sixty-three of 65 hospitals included exceptions to their visitor restriction policies. Setting-specific exceptions included pediatrics, obstetrics/gynecology, emergency department, behavioral health, inpatient rehabilitation, surgery, and outpatient clinics. Exceptions that applied across settings included patients at end of life and patients with disabilities. CONCLUSION: Visitor restriction policies varied significantly among hospitals in this review. These variances create challenges in that their fair application may be problematic and ethical issues related to allocation may arise. Five recommendations are offered for hospitals revising or creating such policies, including that offering transparent, accessible, public-facing policies can minimize ethical dilemmas. In addition, hospitals would benefit from communicating with each other in the development of visitor policies to ensure uniformity and support patients and family members as they navigate hospital visitation.


Subject(s)
COVID-19 , Pandemics , Child , Female , Hospitals , Humans , Policy , Pregnancy , SARS-CoV-2 , United States , Visitors to Patients
3.
Crit Care Med ; 49(10): e1037-e1039, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1475866

ABSTRACT

OBJECTIVES: To determine if a restrictive visitor policy inadvertently lengthened the decision-making process for dying inpatients without coronavirus disease 2019. DESIGN: Regression discontinuity and time-to-event analysis. SETTING: Two large academic hospitals in a unified health system. PATIENTS OR SUBJECTS: Adult decedents who received greater than or equal to 1 day of ICU care during their terminal admission over a 12-month period. INTERVENTIONS: Implementation of a visit restriction policy. MEASUREMENTS AND MAIN RESULTS: We identified 940 adult decedents without coronavirus disease 2019 during the study period. For these patients, ICU length of stay was 0.8 days longer following policy implementation, although this effect was not statistically significant (95% CI, -2.3 to 3.8; p = 0.63). After excluding patients admitted before the policy but who died after implementation, we observed that ICU length of stay was 2.9 days longer post-policy (95% CI, 0.27-5.6; p = 0.03). A time-to-event analysis revealed that admission after policy implementation was associated with a significantly longer time to first do not resuscitate/do not intubate/comfort care order (adjusted hazard ratio, 2.2; 95% CI, 1.6-3.1; p < 0.0001). CONCLUSIONS: Policies restricting family presence may lead to longer ICU stays and delay decisions to limit treatment prior to death. Further policy evaluation and programs enabling access to family-centered care and palliative care during the ongoing coronavirus disease 2019 pandemic are imperative.


Subject(s)
COVID-19/mortality , Decision Making , Health Policy , Visitors to Patients/statistics & numerical data , Adult , Aged , COVID-19/complications , COVID-19/psychology , Critical Illness/mortality , Critical Illness/therapy , Female , Humans , Male , Middle Aged , Terminal Care/methods , Terminal Care/psychology , Terminal Care/standards
6.
Crit Care ; 25(1): 347, 2021 09 25.
Article in English | MEDLINE | ID: covidwho-1438304

ABSTRACT

BACKGROUND: Restricted visitation policies in acute care settings because of the COVID-19 pandemic have negative consequences. The objective of this scoping review is to identify impacts of restricted visitation policies in acute care settings, and describe perspectives and mitigation approaches among patients, families, and healthcare professionals. METHODS: We searched Medline, Embase, PsycINFO, Healthstar, CINAHL, Cochrane Central Register of Controlled Trials on January 01/2021, unrestricted, for published primary research records reporting any study design. We included secondary (e.g., reviews) and non-research records (e.g., commentaries), and performed manual searches in web-based resources. We excluded records that did not report primary data. Two reviewers independently abstracted data in duplicate. RESULTS: Of 7810 citations, we included 155 records. Sixty-six records (43%) were primary research; 29 (44%) case reports or case series, and 26 (39%) cohort studies; 21 (14%) were literature reviews and 8 (5%) were expert recommendations; 54 (35%) were commentary, editorial, or opinion pieces. Restricted visitation policies impacted coping and daily function (n = 31, 20%) and mental health outcomes (n = 29, 19%) of patients, families, and healthcare professionals. Participants described a need for coping and support (n = 107, 69%), connection and communication (n = 107, 69%), and awareness of state of well-being (n = 101, 65%). Eighty-seven approaches to mitigate impact of restricted visitation were identified, targeting families (n = 61, 70%), patients (n = 51, 59%), and healthcare professionals (n = 40, 46%). CONCLUSIONS: Patients, families, and healthcare professionals were impacted by restricted visitation polices in acute care settings during COVID-19. The consequences of this approach on patients and families are understudied and warrant evaluation of approaches to mitigate their impact. Future pandemic policy development should include the perspectives of patients, families, and healthcare professionals. TRIAL REGISTRATION: The review was registered on PROSPERO (CRD42020221662) and a protocol peer-reviewed prior to data extraction.


Subject(s)
COVID-19/prevention & control , Critical Care , Family , Health Policy , Inpatients , Physical Distancing , Visitors to Patients , COVID-19/psychology , COVID-19/transmission , Communication , Family/psychology , Health Personnel/psychology , Humans , Inpatients/psychology , Mental Health Services , Pandemics , Psychological Distress , SARS-CoV-2 , Telephone , Visitors to Patients/psychology
7.
Can J Anaesth ; 68(10): 1474-1484, 2021 10.
Article in English | MEDLINE | ID: covidwho-1392019

ABSTRACT

PURPOSE: In response to the rapid spread of SARS-CoV-2, hospitals in Canada enacted temporary visitor restrictions to limit the spread of COVID-19 and preserve personal protective equipment supplies. This study describes the extent, variation, and fluctuation of Canadian adult intensive care unit (ICU) visitation policies before and during the first wave of the COVID-19 pandemic. METHODS: We conducted an environmental scan of Canadian hospital visitation policies throughout the first wave of the pandemic. We conducted a two-phased study analyzing both quantitative and qualitative data. RESULTS: We collected 257 documents with reference to visitation policies (preCOVID, 101 [39%]; midCOVID, 71 [28%]; and lateCOVID, 85 [33%]). Of these 257 documents, 38 (15%) were ICU-specific and 70 (27%) referenced the ICU. Most policies during the midCOVID/lateCOVID pandemic period allowed no visitors with specific exceptions (e.g., end-of-life). Framework analysis revealed five overarching themes: 1) reasons for restricted visitation policies; 2) visitation policies and expectations; 3) exceptions to visitation policy; 4) patient and family-centred care; and 5) communication and transparency. CONCLUSIONS: During the first wave of the COVID-19 pandemic, most Canadian hospitals had public-facing visitor restriction policies with specific exception categories, most commonly for patients at end-of-life, patients requiring assistance, or COVID-19 positive patients (varying from not allowed to case-by-case). Further studies are needed to understand the consistency with which visitation policies were operationalized and how they may have impacted patient- and family-centred care.


Subject(s)
COVID-19 , Pandemics , Adult , Canada , Humans , Intensive Care Units , Organizational Policy , Policy , SARS-CoV-2 , Visitors to Patients
8.
Psychosomatics ; 61(6): 662-671, 2020.
Article in English | MEDLINE | ID: covidwho-1386490

ABSTRACT

BACKGROUND: Patients with psychiatric illnesses are particularly vulnerable to highly contagious, droplet-spread organisms such as SARS-CoV-2. Patients with mental illnesses may not be able to consistently follow up behavioral prescriptions to avoid contagion, and they are frequently found in settings with close contact and inadequate infection control, such as group homes, homeless shelters, residential rehabilitation centers, and correctional facilities. Furthermore, inpatient psychiatry settings are generally designed as communal spaces, with heavy emphasis on group and milieu therapies. As such, inpatient psychiatry services are vulnerable to rampant spread of contagion. OBJECTIVE: With this in mind, the authors outline the decision process and ultimate design and implementation of a regional inpatient psychiatry unit for patients infected with asymptomatic SARS-CoV-2 and share key points for consideration in implementing future units elsewhere. CONCLUSION: A major takeaway point of the analysis is the particular expertise of trained experts in psychosomatic medicine for treating patients infected with SARS-CoV-2.


Subject(s)
Asymptomatic Infections , Coronavirus Infections/complications , Hospital Design and Construction/methods , Hospital Units , Hospitalization , Infection Control/methods , Mental Disorders/therapy , Personnel Staffing and Scheduling/organization & administration , Pneumonia, Viral/complications , Betacoronavirus , COVID-19 , Humans , Involuntary Commitment , Mental Disorders/complications , Pandemics , Personal Protective Equipment , Psychiatric Department, Hospital , Psychotherapy, Group/methods , Recreation , SARS-CoV-2 , Ventilation/methods , Visitors to Patients
10.
Am J Infect Control ; 49(9): 1105-1112, 2021 09.
Article in English | MEDLINE | ID: covidwho-1330544

ABSTRACT

BACKGROUND: This study examines the impact of visitation and cohorting policies as well as the care home population size upon the spread of COVID-19 and the risk of outbreak occurrence in this setting. METHODS: Agent-based modelling RESULTS: The likelihood of the presence of an outbreak in a care home is associated with the care home population size. Cohorting of residents and staff into smaller, self-contained units reduces the spread of COVID-19. Restricting the number of visitors to the care home to shield its residents does not significantly impact the cumulative number of infected residents and risk of outbreak occurrence in most scenarios. Only when the community prevalence where staff live is considerably lower than the prevalence where visitors live (the former prevalence is less than or equal to 30% of the latter), relaxing visitation increases predicted infections much more significantly than it does in other scenarios. Maintaining a low infection probability per resident-visitor contact helps reduce the effect of allowing more visitors into care homes. CONCLUSIONS: Our model predictions suggest that cohorting is effective in controlling the spread of COVID-19 in care homes. However, according to predictions shielding residents in care homes is not as effective as predicted in a number of studies that have modelled shielding of vulnerable population in the wider communities.


Subject(s)
COVID-19 , Nursing Homes , Visitors to Patients , COVID-19/prevention & control , Disease Outbreaks/prevention & control , Humans , Policy
11.
Can J Anaesth ; 68(10): 1474-1484, 2021 10.
Article in English | MEDLINE | ID: covidwho-1290444

ABSTRACT

PURPOSE: In response to the rapid spread of SARS-CoV-2, hospitals in Canada enacted temporary visitor restrictions to limit the spread of COVID-19 and preserve personal protective equipment supplies. This study describes the extent, variation, and fluctuation of Canadian adult intensive care unit (ICU) visitation policies before and during the first wave of the COVID-19 pandemic. METHODS: We conducted an environmental scan of Canadian hospital visitation policies throughout the first wave of the pandemic. We conducted a two-phased study analyzing both quantitative and qualitative data. RESULTS: We collected 257 documents with reference to visitation policies (preCOVID, 101 [39%]; midCOVID, 71 [28%]; and lateCOVID, 85 [33%]). Of these 257 documents, 38 (15%) were ICU-specific and 70 (27%) referenced the ICU. Most policies during the midCOVID/lateCOVID pandemic period allowed no visitors with specific exceptions (e.g., end-of-life). Framework analysis revealed five overarching themes: 1) reasons for restricted visitation policies; 2) visitation policies and expectations; 3) exceptions to visitation policy; 4) patient and family-centred care; and 5) communication and transparency. CONCLUSIONS: During the first wave of the COVID-19 pandemic, most Canadian hospitals had public-facing visitor restriction policies with specific exception categories, most commonly for patients at end-of-life, patients requiring assistance, or COVID-19 positive patients (varying from not allowed to case-by-case). Further studies are needed to understand the consistency with which visitation policies were operationalized and how they may have impacted patient- and family-centred care.


Subject(s)
COVID-19 , Pandemics , Adult , Canada , Humans , Intensive Care Units , Organizational Policy , Policy , SARS-CoV-2 , Visitors to Patients
12.
J Healthc Qual Res ; 36(5): 263-268, 2021.
Article in Spanish | MEDLINE | ID: covidwho-1275478

ABSTRACT

INTRODUCTION: During the worldwide pandemic of COVID-19 caused by coronavirus SARS-CoV-2, hospitals developed contingency plans that transformed and reorganized the hospital activity. One of the measures was to restrict access to family members of hospitalized patients. The presence of the patient's family is considered an alternative to physical restraint. The aim of this study is to compare the use of physical restraint in hospitalized patients in an acute care hospital during the previous period of the pandemic of COVID-19 with the post-confinement period with hospitals being still closed to family. MATERIAL AND METHODS: We made an observational study that compares the prevalence of physical restraint in an acute care hospital during the previous period to the alarm state (February 2020) with the second period, when visits where restricted (May 2020). From the clinical history of the patients with physical restraint we collected the following variables: sex, diagnostic, hospital admission unit, reason for using physical restraint, localization, length, type of material, registration in the medical record, information given to the family, alternatives to the physical restraint and injuries related to the physical restraint. RESULTS: We evaluated 690 patients: 388 during the previous period and 320 during the second period. From all patients, 29 needed physical restraint. The use of physical restraint went from 8 (2%) to 21 (7%) (p=0.003). In the second period, a not statistically significant increase in continuous physical restraint was identified compared to the first period. CONCLUSIONS: The physical restraint prevalence has been superior during the second period in which families were not present with the hospitalized patients.


Subject(s)
COVID-19/therapy , Family , Restraint, Physical/statistics & numerical data , Visitors to Patients , Acute Disease , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Hospitals , Humans , Male , Middle Aged
13.
J Alzheimers Dis ; 81(4): 1375-1379, 2021.
Article in English | MEDLINE | ID: covidwho-1270983

ABSTRACT

We assessed depression in 72 patients with Alzheimer's disease (AD) who live in retirement homes during the COVID-19-related lockdown. We invited caregivers of 72 patients with AD who live in retirement homes to rate depression in the patients both before and during the lockdown. Analysis demonstrated increased depression in the patients during the lockdown. We attribute this increased depression to the restrictive measures on activities, visits, and physical contact between patients with AD and family members during the lockdown.


Subject(s)
Alzheimer Disease/psychology , Behavior Observation Techniques , COVID-19 , Depression , Family Relations/psychology , Infection Control/methods , Social Isolation/psychology , Aged , Alzheimer Disease/epidemiology , Behavior Observation Techniques/methods , Behavior Observation Techniques/statistics & numerical data , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Caregivers , Depression/diagnosis , Depression/epidemiology , Depression/etiology , Female , France/epidemiology , Humans , Leisure Activities/psychology , Male , Physical Distancing , Residential Facilities/statistics & numerical data , SARS-CoV-2 , Visitors to Patients/psychology , Visitors to Patients/statistics & numerical data
14.
Crit Care ; 25(1): 191, 2021 06 02.
Article in English | MEDLINE | ID: covidwho-1257954

ABSTRACT

Since the lockdown because of the pandemic, family members have been prohibited from visiting their loved ones in hospital. While it is clearly complicated to implement protocols for the admission of family members, we believe precise strategic goals are essential and operational guidance is needed on how to achieve them. Even during the pandemic, we consider it a priority to share strategies adapted to every local setting to allow family members to enter intensive care units and all the other hospital wards.


Subject(s)
COVID-19/prevention & control , Family/psychology , Intensive Care Units/trends , Visitors to Patients , Humans , Intensive Care Units/organization & administration , Professional-Patient Relations , Time Factors
15.
Stud Health Technol Inform ; 281: 53-57, 2021 May 27.
Article in English | MEDLINE | ID: covidwho-1247787

ABSTRACT

Access to hospitals has been dramatically restricted during the COVID 19 pandemic. Indeed, due to the high risk of contamination by patients and by visitors, only essential visits and medical appointments have been authorized. Restricting hospital access to authorized visitors was an important logistic challenge. To deal with this challenge, our institution developed the ExpectingU app to facilitate patient authorization for medical appointments and for visitors to enter the hospital. This article analyzes different trends regarding medical appointments, visitors' invitations, support staff hired and COVID hospitalizations to demonstrate how the ExpectingU system has helped the hospital to maintain accessibility to the hospital. Results shows that our system has allowed us to maintain the hospital open for medical appointments and visits without creating bottlenecks.


Subject(s)
COVID-19 , Mobile Applications , Humans , Pandemics , SARS-CoV-2 , Visitors to Patients
16.
Fam Syst Health ; 39(1): 165-166, 2021 03.
Article in English | MEDLINE | ID: covidwho-1236067

ABSTRACT

In this brief article, the author describes how her husband was first diagnosed with mesothelioma, an incidental finding of routine medical testing. His first surgery was timed to the beginnings of coronavirus (COVID) lockdown. The staging of his cancer aligned with a new stage of the pandemic, and by the time of his first chemotherapy appointment, patients were no longer allowed to bring family along for outpatient visits. Although the author is an expert and educator on psychosocial care in medicine, she has found herself at a complete loss, teaching herself the ropes of how to connect with his treatment team and practicing ambiguous advo cacy. Her hus band will be in recovery for a long time; they will both be in recovery. Mesothelioma has robbed them of certainty and safety, as cancer often does, and just as COVID has done, to everyone. We are all living in the question mark, in the ambiguity-the Con nection is our loneliness, our isolation, and the uncertainty. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
COVID-19/psychology , Mesothelioma/psychology , Professional-Family Relations , COVID-19/epidemiology , Humans , Incidental Findings , Loneliness , Male , Mesothelioma/diagnosis , Mesothelioma/therapy , Middle Aged , Pandemics , SARS-CoV-2 , Social Isolation , Uncertainty , Visitors to Patients
17.
Neurology ; 96(20): e2558-e2560, 2021 05 18.
Article in English | MEDLINE | ID: covidwho-1232452

ABSTRACT

Patients with traumatic brain injury may be dependent on the decision-making of their families. Restrictive visitation policies implemented during the coronavirus disease 2019 (COVID-19) pandemic disproportionately affect these patients and their families. This narrative aims to illustrate this phenomenon and catalyze discussions regarding the need for careful evaluation of restrictive family visitation policies and exceptions that may be required for patients with brain injuries.


Subject(s)
Brain Injuries, Traumatic/therapy , COVID-19/prevention & control , Critical Care , Decision Making, Shared , Head Injuries, Penetrating/therapy , Visitors to Patients , Wounds, Gunshot/therapy , Adult , Critical Care/legislation & jurisprudence , Critical Care/psychology , Critical Care/standards , Glasgow Coma Scale , Humans , Internship and Residency , Male , Neurosurgeons , Palliative Care , Visitors to Patients/legislation & jurisprudence , Visitors to Patients/psychology
18.
Pediatrics ; 148(2)2021 08.
Article in English | MEDLINE | ID: covidwho-1229067

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandemic, many hospitals have added COVID-19-specific visitor restrictions to their routine visitor restrictions. These additional visitor restrictions are designed to reduce viral transmission, protect patients and staff, and conserve personal protective equipment. They typically exempt patients with disabilities and those who are dying. Consistent application of these policies may, however, be inequitable. We present the case of a single mother seeking an individual exemption to both a routine and a COVID-19 specific visitor restriction. One commentator focuses on the importance of clear and transparent processes for considering requests for exceptions. The other argues that disproportionate burdens may be mitigated in other ways and the policy maintained.


Subject(s)
COVID-19 , Pandemics , Humans , Pandemics/prevention & control , Personal Protective Equipment , Policy , SARS-CoV-2 , Visitors to Patients
20.
Chest ; 160(2): 549-557, 2021 08.
Article in English | MEDLINE | ID: covidwho-1220804

ABSTRACT

Family engagement is a key component of high-quality critical care, with known benefits for patients, care teams, and family members themselves. The COVID-19 pandemic led to rapid enactment of prohibitions or restrictions on visitation that now persist, particularly for patients with COVID-19. Reevaluation of these policies in response to advances in knowledge and resources since the early pandemic is critical because COVID-19 will continue to be a public health threat for months to years, and future pandemics are likely. This article reviews rationales and evidence for restricting or permitting family members' physical presence and provides broad guidance for health care systems to develop and implement policies that maximize benefit and minimize risk of family visitation during COVID-19 and future similar public health crises.


Subject(s)
COVID-19 , Family , Visitors to Patients , Guidelines as Topic , Humans
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