Hospitals May Consider Relaxing No-Visitor Policies During Pandemic

 As the COVID-19 pandemic continues, hospitals should consider whether their visitor policies are too restrictive and potentially adopt more nuanced policies that account for community transmission of the virus, careful use of personal protective equipment and vaccine status, according to a group of doctors in Canada.

Many hospitalized patients lacked support this year and struggled emotionally, particularly in intensive-care units, the group writes in the Canadian Medical Association Journal.

"Despite how busy our ICUs were during the first wave of the pandemic, the absence of family presence was palpable," said lead author Dr. Laveena Munshi of Mount Sinai Hospital in Toronto.

"Families and designated care partners are essential members of patient-centered care in the ICU and their role extends beyond comfort," she told Reuters Health by email. "They are patient advocates, they help minimize the impact of delirium, they listen in on our daily ICU rounds and add their insight, and they are substitute decision makers during times when we cannot communicate with patients."

Dr. Munshi and colleagues discuss the research behind hospital visitor policies, ways to bring family members to the bedside safely and how to communicate with family members if they can't visit. During the first wave of the pandemic, they found, hospitals across Canada adopted "no visitor" policies that barred nearly all visitors in an effort to prevent the spread of COVID-19 and reserve personal protective gear for healthcare providers.

As scientists and public-health researchers have learned more about COVID-19, though, more flexible policies may be useful, the authors suggest. Previous studies of visitor policies for the flu and other respiratory diseases found that the benefits of allowing visitors outweigh the harms, especially when visitors wear masks.

Studies have shown that family members and caregivers provide emotional support, help with language barriers, play a role in end-of-life decisions and assist with daily activities such as feeding and mobility.

Hospitals could adapt their policies to distinguish between general visitors and immediate family members or designated caregivers, the authors write, and allow certain visitors in ICUs, hospices, surgical recovery wards and labor and delivery units. Face masks, rigorous cleaning procedures and visitor screening with rapid COVID-19 tests could help as well.

Hospitals should also consider the best ways to communicate with family members and caregivers as the pandemic continues, the authors write. In areas with a high rate of COVID-19 transmission or in instances where visitors aren't allowed, healthcare workers could use video conferencing tools to allow patients to connect with others. When feasible, some hospitals may be able to coordinate visits in outdoor spaces.

"Open communication is foundational to establishing a therapeutic relationship between healthcare providers and the patients and families they serve," said Dr. Joanne Gould Kuntz of the Emory University Hospital in Atlanta, Georgia. Dr. Kuntz, who wasn't involved with the new paper, has researched virtual family meetings for palliative care during the pandemic.

"While video virtual visits do help . . . there is no equal substitute for in-person visitors that can replicate the safety, support and communication that occurs when key family members are able to be present at the bedside," she told Reuters Health by email.

As the pandemic continues in the months ahead, hospitals need a tailored approach based on local and regional infections and should potentially consider visitors' COVID-19 vaccine status, the authors write.

"I am hopeful that widespread vaccination in the coming months will not only reduce the overall infection rates of COVID-19 but also facilitate a return to more normal hospital policies," said Dr. Jordan Cloyd of the Ohio State University Wexner Medical Center in Columbus, who has researched COVID-19 visitor policies and the effect on surgery patients.

"As we embrace another surge of COVID-19 and are set to begin the second year of this pandemic, it is important to modify our policies to reflect what we have learned over the past year in order to optimally balance the benefits and risks to patients, staff and our communities," Dr. Cloyd, who also was not involved with the new report, told Reuters Health by email.

https://www.medscape.com/viewarticle/943208