by Gina Piscitello
(CNN)"Please let me see my mother! She is dying! Please, let me see her!"
These
words, screamed by a daughter being told she will never be able to see
or touch her Covid-positive mother again, echo all too frequently along
the corridors of the hospital where I work. Across the country, the same
scene is playing out in hundreds of health care centers.
Strict visitor restriction
policies are designed to protect hospital staff, patients, family
members and the community from further spread of coronavirus. But these
policies come at a cost. Now, we have data to question whether that cost is worth it.
Visitor restrictions have immense impact on patient and family well-being and mental health, patient choices for medical care, and patient safety.
I have seen patient families try to enter Covid-19 positive rooms,
requiring staff to determine a way to keep these family members safe
while trying to avoid escalating their distress by involving security.
I
have also cared for multiple Covid-positive patients who have chosen to
forgo life-sustaining care — a choice may not have otherwise made — as
this was their only option to be physically present with all their loved
ones before they died. For many Covid-positive patients and their
families, being physically present with one another far outweighs the
risk of spreading Covid-19 to family members, a risk which can be
minimized with recommended precautions.
Although
some hospitals allow visitor exemptions for patients at the end of
life, the number of family members who are allowed to visit is often significantly restricted.
It's gut wrenching each time I have to inform children, parents and
other family members that they will never again be able to see their
loved one again in person.
While these policies were designed to
protect health care workers, patients and visiting family members from
developing Covid-19 — a valid and important concern — there is data to
suggest that these strict restrictions may not be the right way to go
about this.
With aggressive
screening measures, health care workers and patients can be protected
from visitors potentially spreading the virus. For example, hospitals
can evaluate visitors for symptoms of Covid-19, and require a negative
PCR test within 5 days of the visit and a negative same-day rapid
Covid-19 test before seeing their loved one. Covid-19 tests are free and widely available and between the two negative results, there can be a high degree of certainty that the visitor is not infected with Covid-19.
Of course, protecting hospital visitors from Covid-19 is an imperative — and it appears to be possible. A recent JAMA Internal Medicine study
found that health care workers who are supplied with adequate personal
protective equipment have significantly lower rates of Covid-19 than the
general public. This suggests that if family visitors are provided
adequate personal protective equipment, they will be largely protected
from Covid-19 while visiting their relative. Although there is concern personal protective equipment may again fall short due to lower than planned inventory at the Strategic National Stockpile, there are hospitals that have adequate personal protective equipment.
Restrictive visitor policies come at a
tremendous cost, both personally and clinically. Many studies have
reported positive outcomes when families are involved in patient care,
including increased perceptions of patient-centered care, quality of communication, patient safety, and even contributing to improving patient mortality. By denying access to patients, we are also denying them access to these potential benefits.
Hospitals
should reevaluate their visitor restrictions and protocols for Covid-19
patients. Even if there were a higher risk of transmission if family
members are allowed to visit their loved ones, many health care workers
may be willing to take that risk to benefit the patient and family's
health and well-being. And although increasing visitor access to
patients may have potential societal risks of further spread of
Covid-19, this risk can be minimized through the same mechanisms put in
place to protect patients and their loved ones.
If
strict visitor restrictions remain, hospitals should at least increase
access to communication by video and telephone among patients, families,
and medical teams. This responsibility should not fall primarily on
bedside nurses, who already are stretched thin caring for patients.
Selfless nurses have organized video meetings and spent increased time
in Covid-19 positive rooms holding the video device so the family can
see the patient, but the toll of these actions is immense. The faces of
exhausted nurses crying following these video visits will be imprinted
in my mind long after the pandemic is over.
Instead, hospitals should create the
role of a telehealth advocate to arrange meetings and teach family
members how to use video devices. I recently worked on a study that found video visits
are used to connect families with critically ill patients only about
one-tenth of the time. This must be improved. Hospitals can purchase
video devices to allow family members without access to this technology
to connect with their loved one. No one should be denied the chance to
see their loved one because of their inability to pay for a device.
Visitor
restriction policies for hospitalized patients were made with good
intentions to protect patients and staff. But they may be more
restrictive than needed. As we obtain more information about what
precautionary measures work, hospitals should continue to reevaluate
their strict visitor policies. And even as they are doing that, all
hospitals can enhance patient care and ameliorate the emotional trauma
caused by Covid-19 by taking simple steps to improve communication
amongst patients, families and health care clinicians.
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