Hospitals' broad and ongoing restrictions on visits to patients aim to protect patients and staff from COVID-19. But what if the restrictions are worsening overall clinical outcomes, hurting staff morale and increasing costs for hospitals, health plans and patients?
One national quality-improvement advocacy group has raised those concerns amid pandemic-related restrictions, some of which have been mandated by state and local governments.
“We’ve had a lot of concerns about that at Leapfrog, not only because of course from the patient and family perspective it is terribly isolating, but also because patients who have their family nearby or have an advocate with them in the hospital is truly one of the factors that can improve their safety,” Leah Binder, president and CEO of hospital safety organization Leapfrog Group, said this week during the group’s annual meeting.
Robert Cherry, MD, chief medical and quality officer for UCLA Health, said his organization modified “quite draconian” visitor restrictions early in the pandemic to allow one health visitor per patient.
“That really allowed for patients to be able to see their loved ones and recover more effectively,” Cherry said.
The health system also has offered video meetings with family members, posted visitor information online and set up a call center to answer questions about patient care.
Jackson Health System in Miami established a team that uses donated tablet computers during rounding with COVID-19 patients, with the goal of ensuring family communication “once or twice a day.”
“These were tablets that could be cleaned and disinfected, and they ensured patients were having at least that one-on-one with their families and the patients didn’t feel as isolated,” said Isis Zambrana, RN, chief quality officer for Jackson Health.
An issue of national concern
Many states, including Alaska and Michigan, as well as local governments have placed COVID-19-related visitor restrictions on hospitals for various periods during the pandemic, while sometimes allowing visitors for dying patients or those giving birth.
The federal government’s response included a June intervention by the HHS Office of Civil Rights that led Connecticut to reverse some strict visitor restrictions and instead require “hospitals and other acute care settings to permit the entrance of a designated support person for a patient with a disability and permitting family members, service-providers or other individuals knowledgeable about the needs of the person with a disability to serve as a designated support person,” according to a release.
Doug Watson, CFO for the Arizona service area of CommonSpirit Health, said his facilities have aimed to respond to the state’s visitor restrictions by, in part, offering expanded digital visitation options. For instance, the health system has rolled out Medical Memory, a mobile app that allows healthcare providers to record medical-related conversations with patients that can then be shared with their support system outside the hospital walls.
“You’ve got to work within HIPAA, but we have ways that then that can be shared with family members virtually, so that they can get a chance to see some of this before the patient is discharged,” Watson said in an interview.
The health system also has invested in tablet computers to allow patients to connect with family members and include them in clinician conversations as advocates.
“Having a Zoom meeting is not the same as having the person standing next to you, holding your hand, but it is a way to provide that connection and for that family member to participate in a Zoom consultation with a nurse or doctor,” Watson said. “We spent a fair amount of time trying to figure out how you can use technology to keep the families as connected as possible.”
Significance for providers and health plans
Leapfrog has long factored patient-advocate access into its national hospital safety scores.
“One of the pillars of what we recommend people do to protect themselves in the hospital is to have an advocate with them because they are the ones that will catch medication errors and other kinds of errors, ensure you are safe moving around the room and make sure you get what you need during the course of your stay,” Binder said in an interview.
Binder urged more hospitals to adopt policies allowing at least one family member to visit as long as the visitor follows protocols related to personal protective equipment.
Research has long established that patient advocates in the hospital setting improve patients’ clinical outcomes, which in turn lowers their cost of care, Binder said. Their absence could have major cost consequences for health plans, as well as hospitals in value-based payment models, she added.
Beyond the effects on patient outcomes, visitor restrictions also are increasing the burden on clinicians, who have long relied on family visitors to facilitate care, patient communication and accident avoidance within the hospital, Binder said.
“We’ve heard from nurses and others that they hadn’t realized how much they rely on patient advocates during the stay to ensure the patients are taken care of,” Binder said. “Hospitals are extremely busy right now, and they need all of the help they can get to make sure their patients are safe and to make sure that [clinicians] are able to do their job well in very trying circumstances.”
The lack of family visitors also has increased the mental health burden on clinicians, who are the only source of emotional support for seriously ill patients.
“That can be even a crisis-level health issue, and we need to start really taking that seriously from a policy point of view,” Binder said.