Patient care experience with utilization of isolation precautions: systematic literature review and meta-analysis

Abstract

Background: Use of isolation precautions (IP) may represent a trade-off between reduced transmission of infectious pathogens and reduced patient satisfaction with their care. Objective: To perform a systematic literature review and meta-analysis to identify if and how IPs impact patients' care experiences. Data sources: Medline, ClinicalTrials.gov, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PsychInfo, HSRProj and Cochrane Library databases. Study eligibility criteria: Interventional and observational studies published January 1990 to May 2019 were eligible for inclusion. Participants: Patients admitted to an acute-care facility. Interventions: IPs versus no IPs. Methods: Six reviewers screened titles, abstracts and full text. Experience of care reported by patients using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was assessed as the outcome for the meta-analysis. Pooled odds ratios were calculated using the randomeffects model. Heterogeneity was assessed using the I 2 value. Results: After screening 7073 titles and abstracts, 15 independent studies were included in the review. Pooling of unadjusted estimates from the HCAHPS survey demonstrated that IP patients were less likely to give top scores on questions pertaining to respect, communication, receiving assistance and cleanliness compared to the no-IP patients. Patients under IP with longer length of stay appeared to have more negative experiences with the care received during their stay compared to no IP. Conclusions: Patients under IP were more likely to be dissatisfied with several aspects of patient care compared to patients not under IP. It is crucial to educate patients and healthcare workers in order to balance successful implementation of IP and patient care experiences, particularly in healthcare settings where it may be beneficial.

Telehealth Solutions for In-hospital Communication with Patients Under Isolation During COVID-19

“… 26 – 28 Both COVID-19 and non-COVID-19 patients admitted to the hospital are often quite ill, feel isolated from their loved ones, 29 and may be faced with daunting goals of care conversations. 30 For patients who do not speak English, do not own a mobile phone, or are not used to navigating the healthcare system alone, isolation creates additional anxiety. 31 …”

Utilizing Telemedicine in a Novel Approach to COVID-19 Management and Patient Experience in the Emergency Department

“…Attending physicians are only half as likely to conduct examinations on isolated patients, one of many factors contributing to lower Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores from isolated patients for overall care, staff responsiveness, and respectful treatment by providers. [8][9][10] These negative psychological and care delivery outcomes, which were previously documented in the 2003 severe acute respiratory syndrome (SARS) outbreak, are again leading to an increased prevalence of loneliness, anxiety, depression, and even suicide in isolated hospitalized patients during the current COVID-19 pandemic. 11,12 Telemedicine, defined by the Centers for Medicare and Medicaid Services (CMS) as an exchange of medical information from one site to another through electronic communication to improve a patient's health, 13 has been called a ''virtually perfect'' tool to address these issues in the setting of a pandemic.…”

Demographics matter: the potentially disproportionate effect of COVID-19 on hospital ratings

“…Patient perceptions of quality associated with what had been routine care have probably changed due to COVID-19, which may affect the way future surveys will be filled out and utilized [ 26 ]. Further, patient perceptions of quality and representative surveys should be highly scrutinized as some health-care systems with functioning telemedicine programs were able to make seamless adjustments in their care delivery, while others had to rapidly scale up services with a less than optimal perceived patient experience [ 27 , 28 ]. In some instances, high proportions of patients for whom English is not the preferred language may influence quality improvement efforts [ 29 ].…”