New York Medical College, Valhalla, New York (Dr Jaswaney); and Department of Social Medicine (Drs Davis, Cadigan, Waltz, and Joyner and Mx Forcier), School of Medicine (Dr Brassfield), and Department of Pediatrics (Dr Joyner), University of North Carolina Chapel Hill, Chapel Hill, North Carolina.
J Public Health Manag Pract. 2022;28(1):E299-E306. doi: 10.1097/PHH.0000000000001320.
In response to the COVID-19 pandemic, hospitals have developed visitor restriction policies in order to mitigate spread of infection. We reviewed hospital visitor restriction policies for consistency and to develop recommendations to highlight fair and transparent restrictions, exceptions, and appeals in policy development and implementation.
Collection and analysis of public-facing visitor restriction policies during the first 3 months of the pandemic.
General acute care hospitals representing 23 states across all 4 major regions of the United States.
A cohort of the 70 largest hospitals by total bed capacity.
Characteristics of visitor restriction policies including general visitor restriction statement, changes/updates to policies over time, exceptions to policies, and restrictions specific to COVID-19-positive patients.
Sixty-five of the 70 hospitals reviewed had public-facing visitor restriction policies. Forty-nine of these 65 policies had general "no-visitor" statements, whereas 16 allowed at least 1 visitor to accompany all patients. Sixty-three of 65 hospitals included exceptions to their visitor restriction policies. Setting-specific exceptions included pediatrics, obstetrics/gynecology, emergency department, behavioral health, inpatient rehabilitation, surgery, and outpatient clinics. Exceptions that applied across settings included patients at end of life and patients with disabilities.
Visitor restriction policies varied significantly among hospitals in this review. These variances create challenges in that their fair application may be problematic and ethical issues related to allocation may arise. Five recommendations are offered for hospitals revising or creating such policies, including that offering transparent, accessible, public-facing policies can minimize ethical dilemmas. In addition, hospitals would benefit from communicating with each other in the development of visitor policies to ensure uniformity and support patients and family members as they navigate hospital visitation.
应对 COVID-19 大流行，医院制定了访客限制政策，以减少感染传播。我们审查了医院访客限制政策的一致性，并提出建议，以突出政策制定和实施中的公平和透明限制、例外情况和申诉。
在大流行的头 3 个月内收集和分析面向公众的访客限制政策。
代表美国所有 4 个主要地区的 23 个州的综合急性护理医院。
按总床位数计算的 70 家最大医院中的一个队列。
访客限制政策的特征包括一般访客限制声明、政策随时间的变化/更新、政策例外情况以及针对 COVID-19 阳性患者的限制。
在所审查的 70 家医院中，有 65 家医院有面向公众的访客限制政策。这 65 项政策中有 49 项有一般的“无访客”声明，而 16 项政策允许至少 1 名访客陪同所有患者。在 65 家医院中有 63 家医院的访客限制政策中有例外情况。特定于设置的例外情况包括儿科、妇产科/妇科、急诊部、行为健康、住院康复、手术和门诊诊所。适用于所有设置的例外情况包括临终患者和残疾患者。
在本审查中，医院之间的访客限制政策差异很大。这些差异造成了挑战，因为其公平应用可能存在问题，并且可能会出现与分配相关的道德问题。我们提出了五项建议，供医院修订或制定此类政策，包括提供透明、可访问的面向公众的政策可以最大限度地减少道德困境。此外，在制定访客政策时，医院之间进行沟通将有助于确保一致性，并在患者及其家属在医院探视时提供支持。
