07. What were the policies for visitor restriction for patients at end-of-life? How did hospitals define “end-of-life” for the purposes of these exceptions?

a. Of the 43 institutions with information about end-of-life exceptions to visitor restriction policies, only 12 institutions specified a definition for end-of-life. The most commonly used definition (7/12) included the language “Likely to die – days, or unlikely to survive the hospital stay.” 3 institutions defined end-of-life as “withdrawal of life support or care,” 4 institutions deferred to the clinical care team on a “case-by-case basis” to determine an appropriate definition, and 4 institutions noted their end-of-life visitor restriction policy exceptions were not limited to patients on “palliative care” or “comfort care” pathways. Only 1 institution mentioned exceptions relating to end-of-life for discussions about transition to end-of-life care.

b. 27/70 hospitals did not specify exceptions to visitor restriction policies for end-of-life. An additional 12 institutions alluded to exceptions but made no specific comments. Of hospitals who did specify exceptions to general visitor restriction policies for inpatients at end-of-life, 11 institutions had different exceptions based on an inpatient’s COVID-19 status. Of hospitals that indicated the number of visitors allowed for inpatients at end-of-life, 19 hospitals indicated 2 allowed visitors, 7 hospitals indicated more than 2, and 5 indicated less than 2 visitors. Three institutions specified exceptions for “family” versus visitors in general. Only 5 institutions specified the role of clergy within these restrictions. Only 6 institutions clarified whether/how visitors could rotate, or how many were allowed at the bedside at any given time.