Key Clinical Questions – Covid-19 Response

Patient Experience Key Clinical Questions

Patient
Experience

Click on the questions below for more information:

01. What was the timing of visitor restriction policies implemented by hospitals across the United States in response to COVID-19? Did those policies change with time?
02. For whom were the policies intended (e.g., hospital staff vs patients/families)?
03. Did hospitals implement different visitor restriction policies for COVID-19-positive and COVID-19-negative patient populations?
04. For which patient populations or treatment areas did hospitals make exceptions to these visitor restrictions?
05. What screening requirements for visitors did hospitals implement during the COVID-19 pandemic?
06. What accommodations did hospitals provide for visitors or for waiting family members/advocates?
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?
08. Who was responsible for implementing visitor restriction policies at hospitals? What pathways for escalation were introduced if questions about the policies arose?
09. What criteria did hospitals use to determine when visitor restriction policies might end or change?
10. With visitor restrictions in place, what methods of communication were recommended to connect patients to their family/advocates outside the hospital?
11. Did hospitals restrict what items family/advocates could bring or send to patients in the hospital?
12. What mechanisms did hospitals implement to inform family/advocates about the health status of patients in the hospital?

Summary of Key Takeaways, Gaps, and Future Directions

Visitor restriction policies during the COVID-19 pandemic have had far-reaching, long-lasting, and at times unanticipated effects on hospitalized patients — those with and without COVID-19 — and their loved ones. Our analysis of 70 US institutions’ inpatient visitor restriction policies posted to publicly available websites between March and October 2020 revealed wide variability in these proposed policies, highlighting significant gaps in how institutions addressed visitation for specific patient populations (those with behavioral or mental health issues, those at end-of-life, those with limited English proficiency), in how detailed restrictions were communicated to visitors (screening policies, rules for visitor rotation, visitor accommodations), and in how alternative methods of communication were utilized/promoted to ensure consistent exchange of medically relevant information to inpatients’ advocates outside the hospital. Based on this analysis and with input from the HOMERuN PFAC, we have compiled our recommendations for hospitals looking to implement and communicate inpatient visitor restriction policies to their communities. We hope this information can act as a helpful tool for all health care institutions, both during and moving forward from the COVID-19 pandemic.

Gaps Identified from Available Data

A majority of hospitals did not address visitor exceptions for patients with:
- impaired intellectual abilities,
- dementia/delirium,
- when family/advocates would be particularly helpful for both inpatients and their clinical care teams.
Times of admission to/discharge from the hospital were also neglected in terms of consideration for visitor exceptions.
Considerations for patients with limited English proficiency were not addressed by many institutions, including visitor exceptions, availability of interpretation services, and availability of instructions/resources for virtual visitation with family/advocates.
Many institutions specified exceptions to visitor restriction policies at “end-of-life” but the majority of those institutions also failed to specify a clear, consistent definition of “end-of-life” for the purposes of those exceptions.
Most hospitals did not provide personnel contact information or clear escalation policies for family/advocates or staff with questions regarding visitor restrictions.
A majority of institutions did not address expectations or accommodations for allowed inpatient visitors.

Gaps Identified from Patient and Family Advisory Council (PFAC) Reflections

Overall, advocates noted a general lack of consistent, accessible, complete information available publicly from most hospital systems, specifically noting that most institutions did not provide a contact or contact information for patients/advocates with questions about visitor restriction policies.
Policies and language surrounding end-of-life were particularly confusing. Advocates specifically identified discrepancies in the terms hospitals used to refer to end-of-life in visitor restriction policies versus terms patients/advocates are accustomed to hearing, for instance “DNR” and “power of attorney.” They also pointed out that few if any institutions noted whether separate space for grieving would be provided for visitors at end-of-life.
Advocates remarked on a lack of clarity in both general visitor restrictions (2 visitors allowed — During the entire hospital stay? At a time?) as well as the expected behaviors of visitors once they were in the hospital (Allowed to use the restroom? Food available? Can leave and come back?).
Many institutions noted that social distancing would be required once inside the hospital buildings, but advocates found that few hospitals were actually able to implement appropriate distancing and provide space/accommodations for visitors.