COVID‐19 hospital and emergency department visitor policies in the United States: Impact on persons with cognitive or physical impairment or receiving end‐of‐life care

Lo, Alexander X.; Wedel, Logan K.; Liu, Shan W.; Wongtangman, Thiti; Thatphet, Phraewa; Santangelo, Ilianna; Chary, Anita; Biddinger, Paul D.; Grudzen, Corita; Kennedy, Maura

doi:10.1002/emp2.12622

Cited by 16 publications

(13 citation statements)

References 47 publications

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“…Despite the absence of evidence suggesting that visitation policies curbed COVID‐19 transmission, 93% of hospitals in a nationally representative sample had a visitor restriction policy that extended to the ED, with only 39% of those hospitals having exceptions for persons with cognitive impairment. 42 This work underscores the importance of such simple patient protections. As part of the second theme, care partners also noted the limitations of the ED discharge process, including a lack of explanation of testing, results, and next steps.…”

Section: Discussionmentioning

confidence: 77%

“…Within the first theme presented, several care partners of PLWCI noted the chaotic and intense ED environment with amplification experienced with existing COVID‐19 visitation policies. Despite the absence of evidence suggesting that visitation policies curbed COVID‐19 transmission, 93% of hospitals in a nationally representative sample had a visitor restriction policy that extended to the ED, with only 39% of those hospitals having exceptions for persons with cognitive impairment 42 . This work underscores the importance of such simple patient protections.…”

Section: Discussionmentioning

confidence: 78%

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Emergency department care transition barriers: A qualitative study of care partners of older adults with cognitive impairment

Gettel

Serina

Uzamere

et al. 2022

A&D Transl Res & Clin Interv

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INTRODUCTION After emergency department (ED) discharge, persons living with cognitive impairment (PLWCI) and their care partners are particularly at risk for adverse outcomes. We sought to identify the barriers experienced by care partners of PLWCI during ED discharge care transitions. METHODS We conducted a qualitative study of 25 care partners of PLWCI discharged from four EDs. We used the validated 4AT and care partner‐completed AD8 screening tools, respectively, to exclude care partners of older adults with concern for delirium and include care partners of older adults with cognitive impairment. We conducted recorded, semi‐structured interviews using a standardized guide, and two team members coded and analyzed all professional transcriptions to identify emerging themes and representative quotations. RESULTS Care partners’ mean age was 56.7 years, 80% were female, and 24% identified as African American. We identified four major barriers regarding ED discharge care transitions among care partners of PLWCI: (1) unique care considerations while in the ED setting impact the perceived success of the care transition, (2) poor communication and lack of care partner engagement was a commonplace during the ED discharge process, (3) care partners experienced challenges and additional responsibilities when aiding during acute illness and recovery phases, and (4) navigating the health care system after an ED encounter was perceived as difficult by care partners. DISCUSSION Our findings demonstrate critical barriers faced during ED discharge care transitions among care partners of PLWCI. Findings from this work may inform the development of novel care partner‐reported outcome measures as well as ED discharge care transition interventions targeting care partners.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 78%

Emergency department care transition barriers: A qualitative study of care partners of older adults with cognitive impairment

Gettel

Serina

Uzamere

et al. 2022

A&D Transl Res & Clin Interv

View full text Add to dashboard Cite

show abstract

“…Despite the absence of evidence suggesting that visitation policies curbed COVID-19 transmission, 93% of hospitals in a nationally representative sample had a visitor restriction policy that extended to the ED, with only 39% of those hospitals having exceptions for persons with cognitive impairment. 36 This work underscores the importance of such simple patient protections. As part of the second theme, care partners also noted the limitations of the ED discharge process, including a lack of explanation of testing, results, and next steps.…”

Section: Discussionmentioning

confidence: 77%

Emergency department care transition barriers: a qualitative study of care partners of older adults with cognitive impairment

Gettel¹,

Serina

Uzamere³

et al. 2022

Preprint

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INTRODUCTION: After emergency department (ED) discharge, persons living with cognitive impairment (PLWCI) and their care partners are particularly at risk for adverse outcomes. We sought to identify the barriers experienced by care partners of PLWCI during ED discharge care transitions. METHODS: We conducted a qualitative study of 25 care partners of PLWCI discharged from four EDs. We used the validated 4AT and care partner-completed AD8 screening tools, respectively, to exclude care partners of older adults with concern for delirium and include care partners of older adults with cognitive impairment. We conducted recorded, semi-structured interviews using a standardized guide, and two team members coded and analyzed all professional transcriptions to identify emerging themes and representative quotations. RESULTS: Care partners mean age was 56.7 years, 80% were female, and 24% identified as African American. We identified four major barriers regarding ED discharge care transitions among care partners of PLWCI: 1) unique care considerations while in the ED setting impact the perceived success of the care transition, 2) poor communication and lack of care partner engagement was a commonplace during the ED discharge process, 3) care partners experienced challenges and additional responsibilities when aiding during acute illness and recovery phases, and 4) navigating the health care system after an ED encounter was perceived as difficult by care partners. DISCUSSION: Our findings demonstrate critical barriers faced during ED discharge care transitions among care partners of PLWCI. Findings from this work may inform the development of novel care partner-reported outcome measures as well as ED discharge care transition interventions targeting care partners.

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“…During COVID-19, hospital policies have been variable but generally restrictive over long time periods, although some provided limited exceptions for end-of-life care, pediatrics, labor and delivery, and disabled individuals. 6 , 7 Hospitals and clinics sometimes eased visitor restrictions before LTC facilities, but many still enforce policies drastically limiting in-person caregivers, undermining patient- and family-centered care.…”

Section: Overview Of Hospital and Nursing Home Covid-19 Visitor Restr...mentioning

confidence: 99%

Ethical Guidance on Family Caregiving, Support, and Visitation in Hospitals and Residential Health Care Facilities, Including During Public Health Emergencies: an American College of Physicians Position Paper

2023

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Public health emergencies create challenges for the accommodation of visitors to hospitals and other care facilities. To mitigate the spread of COVID-19 early in the pandemic, health care institutions implemented severe visitor restrictions, many remaining in place more than 2 years, producing serious unintended harms. Visitor restrictions have been associated with social isolation and loneliness, worse physical and mental health outcomes, impaired or delayed decision-making, and dying alone. Patients with disabilities, communication challenges, and cognitive or psychiatric impairments are particularly vulnerable without caregiver presence. This paper critically examines the justifications for, and harms imposed by, visitor restrictions during the COVID-19 pandemic and offers ethical guidance on family caregiving, support, and visitation during public health emergencies. Visitation policies must be guided by ethical principles; incorporate the best available scientific evidence; recognize the invaluable roles of caregivers and loved ones; and involve relevant stakeholders, including physicians, who have an ethical duty to advocate for patients and families during public health crises. Visitor policies should be promptly revised as new evidence emerges regarding benefits and risks in order to prevent avoidable harms.

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COVID‐19 hospital and emergency department visitor policies in the United States: Impact on persons with cognitive or physical impairment or receiving end‐of‐life care

Cited by 16 publications

References 47 publications

Emergency department care transition barriers: A qualitative study of care partners of older adults with cognitive impairment

Emergency department care transition barriers: A qualitative study of care partners of older adults with cognitive impairment

Emergency department care transition barriers: a qualitative study of care partners of older adults with cognitive impairment

Ethical Guidance on Family Caregiving, Support, and Visitation in Hospitals and Residential Health Care Facilities, Including During Public Health Emergencies: an American College of Physicians Position Paper

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