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Evidence-informed consensus statements to guide COVID-19 patient visitation policies: results from a national stakeholder meeting.
Fiest, Kirsten M; Krewulak, Karla D; Hernández, Laura C; Jaworska, Natalia; Makuk, Kira; Schalm, Emma; Bagshaw, Sean M; Bernet, Xavier; Burns, Karen E A; Couillard, Philippe; Doig, Christopher J; Fowler, Robert; Kho, Michelle E; Kupsch, Shelly; Lauzier, François; Niven, Daniel J; Oggy, Taryn; Rewa, Oleksa G; Rochwerg, Bram; Spence, Sean; West, Andrew; Stelfox, Henry T; Parsons Leigh, Jeanna.
  • Fiest KM; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada. kmfiest@ucalgary.ca.
  • Krewulak KD; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. kmfiest@ucalgary.ca.
  • Hernández LC; O'Brien Institute of Public Health, Calgary, AB, Canada. kmfiest@ucalgary.ca.
  • Jaworska N; Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. kmfiest@ucalgary.ca.
  • Makuk K; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
  • Schalm E; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
  • Bagshaw SM; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
  • Bernet X; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
  • Burns KEA; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
  • Couillard P; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada.
  • Doig CJ; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
  • Fowler R; Department of Physiotherapy, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada.
  • Kho ME; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
  • Kupsch S; Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada.
  • Lauzier F; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
  • Niven DJ; Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
  • Oggy T; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
  • Rewa OG; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
  • Rochwerg B; Hotchkiss Brain Institute, Calgary, AB, Canada.
  • Spence S; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
  • West A; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
  • Stelfox HT; Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
  • Parsons Leigh J; School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
Can J Anaesth ; 69(7): 868-879, 2022 07.
Article in English | MEDLINE | ID: covidwho-1930581
ABSTRACT

PURPOSE:

Hospital policies forbidding or limiting families from visiting relatives on the intensive care unit (ICU) has affected patients, families, healthcare professionals, and patient- and family-centered care (PFCC). We sought to refine evidence-informed consensus statements to guide the creation of ICU visitation policies during the current COVID-19 pandemic and future pandemics and to identify barriers and facilitators to their implementation and sustained uptake in Canadian ICUs.

METHODS:

We created consensus statements from 36 evidence-informed experiences (i.e., impacts on patients, families, healthcare professionals, and PFCC) and 63 evidence-informed strategies (i.e., ways to improve restricted visitation) identified during a modified Delphi process (described elsewhere). Over two half-day virtual meetings on 7 and 8 April 2021, 45 stakeholders (patients, families, researchers, clinicians, decision-makers) discussed and refined these consensus statements. Through qualitative descriptive content analysis, we evaluated the following points for 99 consensus statements 1) their importance for improving restricted visitation policies; 2) suggested modifications to make them more applicable; and 3) facilitators and barriers to implementing these statements when creating ICU visitation policies.

RESULTS:

Through discussion, participants identified three areas for improvement 1) clarity, 2) accessibility, and 3) feasibility. Stakeholders identified several implementation facilitators (clear, flexible, succinct, and prioritized statements available in multiple modes), barriers (perceived lack of flexibility, lack of partnership between government and hospital, change fatigue), and ways to measure and monitor their use (e.g., family satisfaction, qualitative interviews).

CONCLUSIONS:

Existing guidance on policies that disallowed or restricted visitation in intensive care units were confusing, hard to operationalize, and often lacked supporting evidence. Prioritized, succinct, and clear consensus statements allowing for local adaptability are necessary to guide the creation of ICU visitation policies and to optimize PFCC.
RéSUMé OBJECTIF Les politiques hospitalières interdisant ou limitant les visites des familles à des proches à l'unité de soins intensifs (USI) ont affecté les patients, les familles, les professionnels de la santé et les soins centrés sur le patient et la famille (SCPF). Nous avons cherché à affiner les déclarations de consensus fondées sur des données probantes afin de guider la création de politiques de visite aux soins intensifs pendant la pandémie actuelle de COVID-19 et les pandémies futures, et dans le but d'identifier les obstacles et les critères facilitants à leur mise en œuvre et à leur adoption répandue dans les unités de soins intensifs canadiennes. MéTHODE Nous avons créé des déclarations de consensus à partir de 36 expériences fondées sur des données probantes (c.-à-d. impacts sur les patients, les familles, les professionnels de la santé et les SCPF) et 63 stratégies fondées sur des données probantes (c.-à-d. moyens d'améliorer les restrictions des visites) identifiées au cours d'un processus Delphi modifié (décrit ailleurs). Au cours de deux réunions virtuelles d'une demi-journée tenues les 7 et 8 avril 2021, 45 intervenants (patients, familles, chercheurs, cliniciens, décideurs) ont discuté et affiné ces déclarations de consensus. Grâce à une analyse descriptive qualitative du contenu, nous avons évalué les points suivants pour 99 déclarations de consensus 1) leur importance pour l'amélioration des politiques de restriction des visites; 2) les modifications suggérées pour les rendre plus applicables; et 3) les critères facilitants et les obstacles à la mise en œuvre de ces déclarations lors de la création de politiques de visite aux soins intensifs. RéSULTATS En discutant, les participants ont identifié trois domaines à améliorer 1) la clarté, 2) l'accessibilité et 3) la faisabilité. Les intervenants ont identifié plusieurs critères facilitants à la mise en œuvre (énoncés clairs, flexibles, succincts et hiérarchisés disponibles dans plusieurs modes), des obstacles (manque perçu de flexibilité, manque de partenariat entre le gouvernement et l'hôpital, fatigue du changement) et des moyens de mesurer et de surveiller leur utilisation (p. ex., satisfaction des familles, entrevues qualitatives).

CONCLUSION:

Les directives existantes sur les politiques qui interdisaient ou limitaient les visites dans les unités de soins intensifs étaient déroutantes, difficiles à mettre en oeuvre et manquaient souvent de données probantes à l'appui. Des déclarations de consensus hiérarchisées, succinctes et claires permettant une adaptabilité locale sont nécessaires pour guider la création de politiques de visite en soins intensifs et pour optimiser les soins centrés sur le patient et la famille.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Visitors to Patients / COVID-19 Type of study: Experimental Studies / Qualitative research Limits: Humans Country/Region as subject: North America Language: English Journal: Can J Anaesth Journal subject: Anesthesiology Year: 2022 Document Type: Article Affiliation country: S12630-022-02235-y

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Visitors to Patients / COVID-19 Type of study: Experimental Studies / Qualitative research Limits: Humans Country/Region as subject: North America Language: English Journal: Can J Anaesth Journal subject: Anesthesiology Year: 2022 Document Type: Article Affiliation country: S12630-022-02235-y