Content and Communication of Inpatient Family Visitation Policies During the COVID-19 Pandemic: Sequential Mixed Methods Study

Abstract

Background Inpatient health care facilities restricted inpatient visitation due to the COVID-19 pandemic. There is no existing evidence of how they communicated these policies to the public nor the impact of their communication choices on public perception. Objective This study aims to describe patterns of inpatient visitation policies during the initial peak of the COVID-19 pandemic in the United States and the communication of these policies to the general public, as well as to identify communication strategies that maximize positive impressions of the facility despite visitation restrictions. Methods We conducted a sequential, exploratory, mixed methods study including a qualitative analysis of COVID-19 era visitation policies published on Pennsylvania-based facility websites, as captured between April 30 and May 20, 2020 (ie, during the first peak of the COVID-19 pandemic in the United States). We also conducted a factorial survey-based experiment to test how key elements of hospitals’ visitation policy communication are associated with individuals’ willingness to seek care in October 2020. For analysis of the policies, we included all inpatient facilities in Pennsylvania. For the factorial experiment, US adults were drawn from internet research panels. The factorial survey-based experiment presented composite policies that varied in their justification for restricted visitation, the degree to which the facility expressed ownership of the policy, and the inclusion of family-centered care support plans. Our primary outcome was participants’ willingness to recommend the hypothetical facility using a 5-point Likert scale. Results We identified 104 unique policies on inpatient visitation from 363 facilities’ websites. The mean Flesch-Kincaid Grade Level for the policies was 14.2. Most policies prohibited family presence (99/104, 95.2%). Facilities justified the restricted visitation policies on the basis of community protection (59/104, 56.7%), authorities’ guidance or regulations (34/104, 32.7%), or scientific rationale (23/104, 22.1%). A minority (38/104, 36.5%) addressed how restrictive visitation may impair family-centered care. Most of the policies analyzed used passive voice to communicate restrictions. A total of 1321 participants completed the web-based survey. Visitation policy elements significantly associated with willingness to recommend the facility included justifications based on community protection (OR 1.44, 95% CI 1.24-1.68) or scientific rationale (OR 1.30, 95% CI 1.12-1.51), rather than those based on a governing authority. The facility expressed a high degree of ownership over the decision (OR 1.16, 95% CI 1.04-1.29), rather than a low degree of ownership; and inclusion of family-centered care support plans (OR 2.80, 95% CI 2.51-3.12), rather than no such support. Conclusions Health systems can immediately improve public receptiveness of restrictive visitation policies by emphasizing community protection, ownership over the facility’s policy, and promoting family-centered care.

Family caregivers’ responses to a visitation restriction policy at a Korean surgical intensive care unit before and during the coronavirus disease 2019 pandemic

“…In many Western countries, open and flexible ICU visitation policies were promoted until the COVID-19 pandemic. Since the start of the COVID-19 pandemic, while banning physical visitation became a common practice [ 24 , 32 , 33 ], reports from Canada [ 34 , 35 ], Spain [36] , and the Scandinavian countries [37] have indicated that instead of a complete ban, some institutions limited the number of visitors (e.g., one person at a time) and the duration of visits (e.g., < 30 minutes or one hour per day). In South Korea, open visitation had not been implemented in ICUs in the pre-pandemic period; typically, one or two relatives were allowed to visit for 30 minutes to a maximum of one hour once or twice a day [11] .…”

Usage and limitations of medical consultation with patients’ families using online video calls: a prospective cohort study

“…Electronic and telecommunications technology not only enables telehealth services for patients themselves but can also be a means to assist medical care [ 8 ]. During the COVID-19 outbreak, hospitals and nursing homes restricted family visits to patients to prevent infection [ 9 – 11 ]. However, online visits enabled patients to meet their families [ 12 ].…”

The Impact of Visitor Restrictions During COVID-19 Pandemic on Bereaved Family Members of Patients in Palliative Care Units

“… 7 Guidelines also recommend different visiting conditions according to the condition of infections. 8 , 9 Few studies have investigated the effect of restricted visits on bereaved families in end-of-life care. 10 , 11 …”

“…7 Guidelines also recommend different visiting conditions according to the condition of infections. 8,9 Few studies have investigated the effect of restricted visits on bereaved families in end-of-life care. 10,11 Objective In this study, we surveyed bereaved families, investigating how they evaluate visitor restrictions during the pandemic and how the lack of direct communication with the patient affected them.…”