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Visiting Loved Ones in the Era of COVID-19
To Allow Or Not To Allow - That is the Question
Zainab Al Duhailib and Roman Jaeschke
About the Authors
Zainab Al Duhailib is with the Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh,
Saudi Arabia.
Roman Jaeschke is with the Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Submitted: July 2, 2020. Accepted: July 4, 2020. Published: August 27, 2020. DOI: 10.22374/cjgim.v15i3.473
The COVID-19 pandemic has brought numerous challenges
to our hospital units (in our case, the ICU): Some expected –
such as which antiviral, antimalarial, and anti-inflammatory
drugs to use, when to intubate, and how to ventilate? Some less
predictable, not even concerning patients with COVID-19 but,
in retrospect, possibly equally important.
With so much uncertainty about the spread of disease and
concerns about personal protective equipment (PPE) availability,
many health care institutions, out of caution, limited non-
medically related contact with patients and their caregivers, which
frequently included a policy of no hospital visits to patients by
family and friends.
Restrictions concerning visits to health care facilities have
generated a multitude of emotions and opinions. Those following
the news over the last few months have witnessed numerous
pictures of people standing outside the doors and windows of
health care facilities and doing their best to communicate with
their loved ones, the patients, inside a separate room.
Discussions among our colleagues from different institutions
and through the feedback received from families led us to
understand how the importance of physical contact sometimes
superseded the importance of most of the other elements of
clinical care we provided.
Against this background, we explored the way people
perceive hospital visits in the era of COVID-19 and possible
future pandemics. This effort was not designed to find out
what is right; we do not have the methods or the data to find
an answer to that question. Our goal was to explore what we
currently think.
Using the MetaClinician® survey platform, we asked two
questions in a survey that was distributed to an interprofessional
sample of international work colleagues:
Assume your ICU patient does not have COVID-19, but
some other patients in the unit do. Many COVID-19 cases
originate in health care settings (true). Some families tell
us not allowing visits causes suffering (true). How should
we behave, and how could we ease the pain during this
pandemic or the next? Lets learn from each other. Please
provide your ideas in the feedback section.
The second question was identical, except the hypothetical
patient had COVID-19.
The responses included:
We should not allow visits to areas with COVID-19 patients.
We should make exception for patients who are very
likely to die.
We should allow periodic visits (for example, weekly)
using all required precautions (PPE).
Families should have the rights to visit periodically (using
required PPE); we should figure out how to do it safely.
Within one week, we received over 100 total responses from
nurses (approximately 40%), physicians (approximately 60%),
and isolated responses from pharmacists, physiotherapists,
and respiratory therapists. Although most responses came
from Ontario, clinicians from 6 countries outside of Canada
provided input.
The Table 1 depicts the range of responses to our questions
concerning visits to ICU patients with COVID-19:
Canadian Journal of General Internal Medicine
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Duhailib and Jaeschke
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The first observation was that we, as individuals, consider
different solutions as appropriate. This is not unexpected, although
such differences were observed among physicians in charge of
large ICUs and infectious disease specialists. It just reminded us
that being aware of our collective opinions decreases the degree
of certainty in our own opinions.
Second, we (re)discovered ways that people deal with the
problem of communication in the COVID-19 era. Respondents
repeatedly mentioned the use of phones, tablets, and computers
for communication. In one ICU, a senior medical student was
assigned to each patient with COVID-19 for the sole purpose
of communicating with families. In another response, the
attending physician, after finishing clinical rounds, contacted
each family to update them about each patients status (referred
to as “family rounds”).
Third, although the interactions were mostly electronic, those
respondents to the survey whom we contacted directly consistently
highlighted the major emotional impact associated with such
communications. This reminded us of an ICU colleague who
wrote about his reflections on practice: “I know that years later,
no one—neither family members nor health care providers—will
remember how well we managed the blood glucose or ventilator
settings. They will remember that we knew their loved one by name
and sought to see them as fellow human beings. They will recall that
we helped them to experience the final hours on their own terms,
and that above all, we truly cared.” [https://empendium.com/
mcmtextbook/potw/173231,publications-of-the-week-october9]
Although this was an exploratory and informal survey,
with a convenience sample of clinicians who were mostly from
Ontario, we considered these findings important to share, given
the extraordinary times we are living through. We invite readers
to share their own views, provide comments and feedback
(you will be able to do it with MetaClinician®) and, through
this compilation of viewpoints, identify potential solutions to
help us better care for patients and their families during this
pandemic or the next. We invite you to contribute to this QI
project accessing http://metaclinician.com/hospitalvisit. Please
join us in this venture to share views on practicing during these
challenging times.
Acknowledgments
We would like to acknowledge the important and valuable input
of Dr. Deborah Cook who reviewed and provided valuable
suggestions to this manuscript.
Table 1. Range of Responses
Canadian Journal of General Internal Medicine
Volume 15, Issue 3, 2020 27
Commentary
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