An environmental scan of visitation policies in Canadian intensive care units during the first wave of the COVID-19 pandemic

Abstract

Purpose In response to the rapid spread of SARS-CoV-2, hospitals in Canada enacted temporary visitor restrictions to limit the spread of COVID-19 and preserve personal protective equipment supplies. This study describes the extent, variation, and fluctuation of Canadian adult intensive care unit (ICU) visitation policies before and during the first wave of the COVID-19 pandemic. Methods We conducted an environmental scan of Canadian hospital visitation policies throughout the first wave of the pandemic. We conducted a two-phased study analyzing both quantitative and qualitative data. Results We collected 257 documents with reference to visitation policies (preCOVID, 101 [39%]; midCOVID, 71 [28%]; and lateCOVID, 85 [33%]). Of these 257 documents, 38 (15%) were ICU-specific and 70 (27%) referenced the ICU. Most policies during the midCOVID/lateCOVID pandemic period allowed no visitors with specific exceptions (e.g., end-of-life). Framework analysis revealed five overarching themes: 1) reasons for restricted visitation policies; 2) visitation policies and expectations; 3) exceptions to visitation policy; 4) patient and family-centred care; and 5) communication and transparency. Conclusions During the first wave of the COVID-19 pandemic, most Canadian hospitals had public-facing visitor restriction policies with specific exception categories, most commonly for patients at end-of-life, patients requiring assistance, or COVID-19 positive patients (varying from not allowed to case-by-case). Further studies are needed to understand the consistency with which visitation policies were operationalized and how they may have impacted patient- and family-centred care. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-021-02049-4.

Impact of COVID-19 visitor restrictions on healthcare providers in Canadian intensive care units: a national cross-sectional survey

“…A recent environmental scan of Canadian adult intensive care unit (ICU) visitation policies during the first wave of COVID-19 revealed that 86% of hospitals altered their policies to prohibit or restrict visitors. 1 The restrictive visitation policies were designed to limit the spread of SARS-CoV-2 and to protect the healthcare workforce in the face of uncertainty, yet often neglected the important role of essential care partners. Meanwhile, fear of infection, elevated workloads, and emotional exhaustion caused stress for healthcare providers.…”

A Modified Delphi Process to Prioritize Experiences and Guidance Related to ICU Restricted Visitation Policies During the Coronavirus Disease 2019 Pandemic

“…With the vaccination rate increasing, existing consensus statements will need to be revisited and revised based on emerging evidence of risk and transmissibility to inform visitation policies that consider a visitor’s vaccination status. Sixth, the generalizability of these findings is limited to setting such as Canada where, pre-pandemic, most ICUs had open visitation (24 hr) ( 4 ) and, as such, may not be applicable to jurisdictions with restricted/limited visitation. Future work is needed to understand the barriers to the implementation and facilitators/barriers of adoption of these evidence-informed consensus statements and their sustained uptake during the current and future pandemics.…”

“…Patient- and family-centered care (PFCC) is an essential component of high-quality critical care medicine ( 1 ). In response to the increasing number of patients with coronavirus disease 2019 (COVID-19) infection and limited knowledge regarding viral transmission, hospitals enacted strict visitation restrictions to mitigate potential spread of COVID-19 and preserve personal protective equipment ( 2 – 4 ). These restricted visitation policies prohibited the presence of family members for all hospitalized patients, including ICUs, with limited exceptions (e.g., end-of-life) ( 4 ).…”

Consequences of visitor restriction policies in the intensive care unit during the COVID-19 pandemic

“…présentent les résultats de leur étude de milieu qui décrit l'ampleur, les variations et les fluctuations des restrictions relatives aux visites aux unités de soins intensifs pour adultes au Canada avant (pré-COVID) et à deux points de temps (mid-COVID et COVID-tardif) au cours de la première vague de la pandémie de COVID-19 au Canada. 3 Sur la base de 257 documents décrivant les politiques de visite de 230 hôpitaux/USI canadiens, les auteurs rapportent qu'avant la COVID, plus des deux tiers des USI autorisaient les visites « libres » (24 heures sur 24). Sans surprise, aucun hôpital n'a maintenu les visites libres pendant la pandémie, la majorité adoptant une politique de « visites interdites » hormis pour des exceptions prédéterminées (mid-COVID : 86 %; COVID-tardif : 76 %).…”

“…In this issue of CJA, Fiest et al report the findings of their environmental scan which describes the extent, variations, and fluctuations of Canadian adult ICU visitation restrictions before (preCOVID) and at two timepoints (midCOVID and lateCOVID) during the first wave of the COVID-19 pandemic in Canada. 3 Based on 257 visitation policy documents from 230 Canadian hospitals/ ICUs, they report that preCOVID, over twothirds of ICUs permitted ''open'' (24-hr) visitation. Unsurprisingly, none of the hospitals retained open visitation during the pandemic, with the majority adopting a ''no visitor'' policy with pre-specified exceptions (midCOVID: 86%; lateCOVID: 76%).…”