Hospital Policies During COVID-19: An Analysis of Visitor Restrictions

Abstract

Objective:In response to the COVID-19 pandemic, hospitals have developed visitor restriction policies in order to mitigate spread of infection. We reviewed hospital visitor restriction policies for consistency and to develop recommendations to highlight fair and transparent restrictions, exceptions, and appeals in policy development and implementation. Design: Collection and analysis of public-facing visitor restriction policies during the first 3 months of the pandemic. Setting: General acute care hospitals representing 23 states across all 4 major regions of the United States. Participants: A cohort of the 70 largest hospitals by total bed capacity. Measurements: Characteristics of visitor restriction policies including general visitor restriction statement, changes/ updates to policies over time, exceptions to policies, and restrictions specific to COVID-19-positive patients. Results: Sixty-five of the 70 hospitals reviewed had public-facing visitor restriction policies. Forty-nine of these 65 policies had general "no-visitor" statements, whereas 16 allowed at least 1 visitor to accompany all patients. Sixty-three of 65 hospitals included exceptions to their visitor restriction policies. Setting-specific exceptions included pediatrics, obstetrics/gynecology, emergency department, behavioral health, inpatient rehabilitation, surgery, and outpatient clinics. Exceptions that applied across settings included patients at end of life and patients with disabilities. Conclusion:Visitor restriction policies varied significantly among hospitals in this review. These variances create challenges in that their fair application may be problematic and ethical issues related to allocation may arise. Five recommendations are offered for hospitals revising or creating such policies, including that offering transparent, accessible, public-facing policies can minimize ethical dilemmas. In addition, hospitals would benefit from communicating with each other in the development of visitor policies to ensure uniformity and support patients and family members as they navigate hospital visitation.

Patients With Serious Injection Drug Use–Related Infections who Experience Patient-Directed Discharges on Oral Antibiotics Have High Rates of Antibiotic Adherence but Require Multidisciplinary Outpatient Support for Retention in Care

“…The implementation of this quality improvement intervention in February 2020 coincided with the onset of the COVID-19 pandemic. Similar to infection prevention practices at many US institutions [ 21 ], inpatients were not allowed visitors or to leave their rooms. These restrictions posed a significant challenge for PWID who required multiweek hospitalizations and may account for the high degree of PDD we observed during the study period.…”

Centering the Right to Health of Childbearing People in the US During the COVID-19 Pandemic

“…During a period of intense emotional and physical stress, birthing persons should have access to a support person to weigh-in on decision-making and advocate for the client as needed ( 22 ). Despite these early concerns, an analysis of hospital policies throughout the US found that 66% of hospitals in the study only allowed one visitor, 23% allowed two visitors, and the remaining 11% worked on a case-by-case basis or had no established protocol ( 23 ). These restrictions have often been re-implemented in recent surges, threatening childbearing people's right to support.…”

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

“…Jaswaney examined visitor policies using a non‐random sample of the 70 largest metropolitan US hospitals from 24 states and similarly found that 93% had visitor policies and 46% had ED‐specific policies, and a higher proportion of hospitals with exceptions for end‐of‐life care (78%) and for patients with any “disabilities” (54%), with that category including cognitive impairment. 26 …”

“…Jaswaney examined visitor policies using a non-random sample of the 70 largest metropolitan US hospitals from 24 states and similarly found that 93% had visitor policies and 46% had ED-specific policies, and a higher proportion of hospitals with exceptions for end-of-life care (78%) and for patients with any "disabilities" (54%), with that category including cognitive impairment. 26 As the SARS-CoV-2 virus may be transmitted by asymptomatic persons, 27 prised 11% and all physicians 13%, with the remainder patients and other employees. 28 Although our study found that visitor restrictions were widely implemented, their impact on infection control remains unclear.…”