Opinion: Hospitals Should Re-evaluate Restrictive Visiting Policies During Pandemic

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These words, shouted by a girl who is told she will never be able to see or touch her Covid-positive mother again, resonate too often in the hallways of the hospital where I work. Across the country, the same scene is playing out in hundreds of health centers.

Strict visitor restriction policies are designed to protect hospital staff, patients, family members and the community from the spread of the coronavirus. But these policies come at a cost. Now we have data to ask if this cost is worth it.

Visitor restrictions have an immense impact on patient and family well-being and mental health, patient choices for medical care and patient safety. I have seen families of patients try to enter rooms that are positive for Covid-19, forcing staff to figure out a way to protect these family members while trying to avoid making their distress worse by involving security .

I have also treated several Covid positive patients who chose to forgo survival care – a choice might not have been made otherwise – as it was their only option to be physically present with all their loved ones before. their death. For many Covid-positive patients and their families, being physically present with each other far outweighs the risk of transmitting Covid-19 to their family members, a risk that can be minimized with recommended precautions.

Although some hospitals allow visiting exemptions for dying patients, the number of family members allowed to visit is often severely limited. It is heartbreaking every time I have to tell children, parents and other family members that they will never be able to see their loved one again in person.

While these policies were designed to protect visiting health workers, patients and family members from the development of Covid-19 – a valid and important concern – there is some evidence to suggest that these strict restrictions cannot be -be not the right way to proceed.

With aggressive screening measures, health workers and patients can be protected from visitors who can spread the virus. For example, hospitals may assess visitors for symptoms of Covid-19 and require a negative PCR test within 5 days of the visit and a rapid negative same-day Covid-19 test before seeing their loved one. Covid-19 tests are free and widely available and between the two negative results there can be a high degree of certainty that the visitor is not infected with Covid-19.

Of course, protecting hospital visitors from Covid-19 is an imperative – and it seems possible. A recent study by JAMA Internal Medicine found that healthcare workers who receive proper personal protective equipment have significantly lower rates of Covid-19 than the general public. This suggests that if family visitors are provided with adequate personal protective equipment, they will be largely protected from Covid-19 when they visit their relative. Although there are fears that personal protective equipment may again be insufficient due to an inventory lower than forecast for the national strategic stock, some hospitals have adequate personal protective equipment.

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Visitor restriction policies come at a huge cost, both personally and clinically. Numerous studies have reported positive results when families are involved in patient care, including an increased perception of patient-centered care, quality of communication, patient safety and even a contribution to improving patient mortality. By denying access to patients, we are also denying them access to these potential benefits.

Hospitals should re-evaluate their visiting restrictions and protocols for Covid-19 patients. Even if there was a higher risk of transmission if family members were allowed to visit loved ones, many health workers might be willing to take this risk for the benefit of the health and well-being of the patient. patient and family. And while increasing visitor access to patients may present potential societal risks of the spread of Covid-19, this risk can be minimized through the same mechanisms put in place to protect patients and their loved ones.

If strict restrictions on visitors remain, hospitals should at least increase access to video and phone communication between patients, families and medical teams. This responsibility should not lie primarily with staff nurses, who are already caring for patients. Selfless nurses held video meetings and spent more time in Covid-19 positive rooms holding the video device so the family could see the patient, but the toll of these actions is immense. The faces of exhausted nurses crying after these video tours will remain etched in my mind long after the pandemic is over.

Instead, hospitals should create the role of a telehealth advocate to organize meetings and teach family members how to use video devices. I recently worked on a study that found that video tours are only used to connect families with critically ill patients about a tenth of the time. It needs to be improved. Hospitals can purchase video devices to allow family members without access to this technology to connect with their loved one. No one should be denied the chance to see their loved one because of their inability to pay for a device.

The visitor restriction policies for inpatients have been developed with good intentions to protect patients and staff. But they can be more restrictive than necessary. As we gain more information on effective precautionary measures, hospitals should continue to reassess their strict visitor policies. And even by doing this, all hospitals can improve patient care and lessen the emotional trauma caused by Covid-19 by taking simple steps to improve communication between patients, families and healthcare clinicians.

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