Perspectives on Visitors in the Emergency Department: Their Role and Importance

Totten, Vicken Y.; Bryant, Tara K.; Chandar, Apoorva K.; Hoch, Wyatt B.; Hunter, Stephanie L.; Patel, Nikita; Brenner, Barry E.

doi:10.1016/j.jemermed.2013.04.057

Cited by 4 publications

(9 citation statements)

References 24 publications

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“… 11–13 Totten et al 13 found that 78% of patients in the ED felt their companion was important to their care for social support and advocacy. 13 Although there are no official guidelines for companions in the ED, there is a large body of literature in support of companion presence in other healthcare settings such as maternal care and the intensive care unit (ICU). 33 34 For example, the WHO has issued recommendations for companions of choice to be present during labour and childbirth and argues that having a companion they trust contributes to women feeling safe and strong, and leads to improved maternal and perinatal outcomes.…”

Section: Discussionmentioning

confidence: 99%

Companion restrictions in the emergency department during COVID-19: physician perceptions from the Western Cape, South Africa

2023

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ObjectivesTo determine emergency department (ED) physicians’ perceptions regarding hospital companions being prohibited from accompanying the patient during COVID-19.DesignTwo qualitative datasets were combined. Data collected included voice recordings, narrative interviewing and semistructured interviews. A reflexive thematic analysis was conducted and guided by the Normalisation Process Theory.SettingSix hospital EDs in the Western Cape, South Africa.ParticipantsConvenience sampling was used to recruit a total of eight physicians working full time in the ED during COVID-19.ResultsThe lack of physical companions provided an opportunity for physicians to assess and reflect on a companion’s role in efficient patient care. Physicians perceived that the COVID-19 restrictions illuminated that patient companions engaged in the ED as providers contributing to patient care by providing collateral information and patient support, while simultaneously engaging as consumers detracting physicians from their priorities and patient care. These restrictions prompted the physicians to consider how they understand their patients largely through the companions. When companions became virtual, the physicians were forced to shift how they perceive their patient, which included increased empathy.ConclusionThe reflections of providers can feed into discussions about values within the healthcare system and can help explore the balance between medical and social safety, especially with companion restrictions still being practised in some hospitals. These perceptions illuminate various tradeoffs physicians had to consider throughout the pandemic and may be used to improve companion policies when planning for the continuation of the COVID-19 pandemic and future disease outbreaks.

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Section: Discussionmentioning

confidence: 99%

Companion restrictions in the emergency department during COVID-19: physician perceptions from the Western Cape, South Africa

2023

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“…ED patients usually need some assistance from visitors. Totten et al [10] defined the roles of visitors, especially persons accompanying patients to the ED, as providing emotional support and physical help to patients and helping bridge the gap between doctors and patients. However, despite the positive role of visitors, because they come in close contact with patients with infectious diseases, they are able to facilitate the spread of infectious diseases; this is why frequent, unlimited visits to the ED need to be controlled.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the number of emergency department visitors

et al. 2022

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Objective: Uncontrolled emergency department (ED) visits lead to crowding and increase the time patients are in the ED. Following the 2015 Middle East respiratory syndrome (MERS) outbreak in Korea, EDs began to regulate visitors. The purpose of this study was to examine the results of regulating ED visits and to identify factors associated with increased ED visits. Methods: We conducted a cross-sectional observational study using patient information recorded in a visitor's book during the MERS outbreak from July 6 to July 26, 2015. The visitor's book included the patient's and visitor's names, their relationship, and the day and time of the visit. The collected patient information included sex, age, mode of visit, length of stay in the ED, and disposition. The risk ratio and 95% confidence interval for each variable were calculated using Poisson regression. The primary outcome of this study was the number of visitors per patient according to their characteristics. Results: Overall, 4,139 patients and 5,642 visitors were registered during the study period. More people visited during weekdays and office hours. The characteristics of patients that increased visitors per patient were when the mode of visit was a public ambulance and when the length of stay in the ED was longer than 12 hours. Conclusion: During the study period, ED visits were strongly controlled by a government guidance, but there was still a significant number of visitors. If we do not restrict visitors, infection control in the ED will be difficult. It is urgent to develop policies and cultural improvement to control ED visits.

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“…Also, there are many different types and levels of relative involvement [14], which means that involvement is not simply a question of being involved or not. Relatives may be involved in contributing important information about the patient's personal or medical situation, helping the patient with practical, social, and emotional support, as well as acting as coordinators, advocates, and family caregivers for the patient in his or her clinical pathway [15][16][17]. Despite the possibility of differences of perspectives, there is no dispute as to the importance and benefits of involving relatives in the clinical pathway.…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, the medical staff in the ED ward have little time to build relations, obtain necessary information, and assess the patient's situation [18]. Studies have also shown that involving relatives is challenging because relatives might not be present during the patient's visit to the ED [17,21]. Some patients do not want their relatives to become involved [21], some patients arrive alone [16,17,19,21] and some relatives are only temporarily present during the patient's visit to the ED [17].…”

Section: Introductionmentioning

confidence: 99%

“…Studies have also shown that involving relatives is challenging because relatives might not be present during the patient's visit to the ED [17,21]. Some patients do not want their relatives to become involved [21], some patients arrive alone [16,17,19,21] and some relatives are only temporarily present during the patient's visit to the ED [17]. At times, relatives who are in fact present and willing to be involved find that the nursing staff excludes them from being involved in the patient's clinical pathway [22].…”

Section: Introductionmentioning

confidence: 99%

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Involvement un-enabled? An ethnographic study of the challenges and potentials of involving relatives in the acute ambulatory clinical pathway

Sagoo

Grytnes

2020

BMC Health Serv Res

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Background Involving a patient’s relatives is a complex endeavour, especially in emergency departments (EDs). Generally, relatives are recognized as vital partners in health care, but in-depth knowledge on how these family involvement processes take place in the everyday practices of EDs is sparse. The aim of this study is to explore the practice of involving relatives in the acute ambulatory clinical pathway in the ED, as seen from the perspectives of patients and relatives. Methods The study was conducted as ethnographic fieldwork in an ED at a Danish Regional Hospital. Two months of participant-observation were carried out focusing on 43 patients. Of these, 18 patients and/or relatives were selected for telephone interviews after 1 week, and of these 11 were selected for in-depth interviews 3 weeks later. Results Unpredictability is a basic condition of any ED. For the patients and relatives, who are unfamiliar with the routines in the ED, unpredictability translates to a sense of temporal and existential unpredictability, reinforced by a sense of not knowing when the examinations will be completed or if/when they will be sent home. Relatives’ involvement in the ED is affected by this sense of unpredictability and by the existing relations between patients and their relatives prior to entering the ED. The stay in the ED is only one ‘stop’ in the complete acute ambulatory clinical pathway but relatives’ involvement also concerns the time before and after the stay in the ED. Practices of involving relatives leave (some) relatives invisible in the clinical pathway. As a consequence, they are often not addressed, which un-enables their involvement. Conclusion Involvement of relatives presupposes recognizing the relatives as participants if they are to be involved in the patient’s clinical pathway in the ED. As a start, it is advisable that the medical staff ask the patients on arrival who has accompanied them in the ED, and if and in what way they want their companions involved in the ED. There is a need for a more integrated and contextualized understanding of relatives’ involvement, as it takes place along an extended acute ambulatory clinical pathway.

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Perspectives on Visitors in the Emergency Department: Their Role and Importance

Cited by 4 publications

References 24 publications

Companion restrictions in the emergency department during COVID-19: physician perceptions from the Western Cape, South Africa

Companion restrictions in the emergency department during COVID-19: physician perceptions from the Western Cape, South Africa

Factors associated with the number of emergency department visitors

Involvement un-enabled? An ethnographic study of the challenges and potentials of involving relatives in the acute ambulatory clinical pathway

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