Changes to Visitation Policies and Communication Practices in Michigan ICUs during the COVID-19 Pandemic

Abstract

Critically ill patients are often unable to communicate, placing the onus on clinicians in ICUs to engage family members. In the United States, practice has gradually shifted toward including family members in ICU rounds (1). However, the novel coronavirus disease (COVID-19) pandemic dramatically altered hospital care in the United States. For example, early reports suggested many hospitals restricted access to visitors (2). We sought to understand changes to visitation policies and strategies used to communicate with family members because of COVID-19. We identified all hospitals with ICUs in the state of Michigan using the 2018 American Hospital Association annual survey database and by Internet searches. In early April, Michigan's statewide ICU occupancy was 71%, the fifth highest in the United States (3). Within each hospital, an ICU physician or nurse leader from a medical ICU was identified and surveyed over the telephone between April 6, 2020, and May 8, 2020. If the ICU leader was unavailable by telephone, an online survey was conducted. Participants were asked 1) whether their hospital made any changes to its visitation policy; 2) what changes were made; 3) whether their ICU had changed the way it routinely communicated with family members; and 4) what strategies their ICU was using to communicate with family members. x 2 and t tests were used to compare responding and nonresponding hospitals. All tests were two sided, with a P value of less than 0.05 considered significant. This research was deemed to be exempt from review by the University of Michigan Institutional Review Board (HUM00179422). We surveyed 49 out of 89 Michigan hospitals with ICUs (response rate = 55%). Characteristics between responding and nonresponding hospitals were similar (Table 1). All 49 responding hospitals had changes to their visitation policies because of COVID-19 (Figure 1). One hospital (2%) indicated

Causes and Circumstances of Death among Patients Hospitalized with COVID-19: A Retrospective Cohort Study

“…In addition, patients and families had minimal face-to-face interaction with their healthcare team, with less than half of patients and families having face-to-face goals-ofcare discussions. These findings likely reflect the impact of restricted visitation policies established during the pandemic, both in Michigan and elsewhere (7,8). In addition, despite the wide availability of videoconferencing tools (9), videoconferencing was rarely used for discussing goals-of-care.…”

Clinician Perspectives on Caring for Dying Patients During the Pandemic

“…Although technology and time constraints may threaten human connection in the hospital at the best of times ( 1 ), compassionate end-of-life care for critically ill patients has seldom been more challenging than during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic ( 2 ). The mortality associated with serious infection necessitated public health measures to restrict family presence in the hospital and to conserve limited quantities of personal protective equipment (PPE) ( 3 , 4 ). The devastation of SARS-CoV-2 has separated patients from families ( 5–8 ) and created professional angst ( 9–11 ), particularly when caring for dying patients who are alone in grappling with their grief.…”

“…The devastation of SARS-CoV-2 has separated patients from families ( 5–8 ) and created professional angst ( 9–11 ), particularly when caring for dying patients who are alone in grappling with their grief. Relatives unable to be with a hospitalized loved one report that they fear not being there to tell clinicians what the patient is “really like” ( 3 ).…”

Pragmatic Recommendations for Infection Prevention and Control Practices for Healthcare Facilities in Low- and Middle-Income Countries during the COVID-19 Pandemic

“…A survey of intensive care units in the United States found that nearly all hospitals implemented “no-visitor” policies, with certain exceptions at the end-of-life. 58 Strict visitation policies were also implemented by the National Health Service in the United Kingdom. 59 In Taiwan, most hospitals changed visiting policies, with some implementing no-visitor policies and others restricting the number of visitors and visiting hours, paired with symptom and temperature monitoring to screen visitors.…”