key: cord-0789666-vor2ngce
authors: Weiner, Hillary S.; Firn, Janice I.; Hogikyan, Norman D.; Jagsi, Reshma; Laventhal, Naomi; Marks, Adam; Smith, Lauren; Spector-Bagdady, Kayte; Vercler, Christian J.; Shuman, Andrew G.
title: Hospital Visitation Policies During the SARS-CoV-2 Pandemic
date: 2020-09-28
journal: Am J Infect Control
DOI: 10.1016/j.ajic.2020.09.007
sha: 0eaf8127302fb7e917f96397044b1908dbd06348
doc_id: 789666
cord_uid: vor2ngce

A significant change for patients and families during SARs-CoV-2 has been the restriction of visitors for hospitalized patients. We analyzed SARs-CoV-2 hospital visitation policies and found widespread variation in both development and content. This variation has the potential to engender inequity in access. We propose guidance for hospital visitation policies for this pandemic to protect, respect, and support patients, visitors, clinicians, and communities.

During the SARS-CoV-2 pandemic, policies and patient care rapidly transformed as U.S. hospitals endeavored to treat patients, protect public health, and steward resources. 1,2 One major change was visitor restriction within clinical environments. 3, 4 The impact, content, underlying ethical principles, stakeholder involvement, and accessibility and transparency of SARS-CoV-2 visitor policies remains underexplored. 5 Comparison of SARS-CoV-2 visitor policies could reduce inconsistencies in policy application and promote more equitable care. Here, we analyze, compare, and describe visitor policy content with the goal of providing guidance for future visitation policies.

We conducted a content analysis of thirteen SARS-CoV-2 visitor policies within we inquired about policy creation and visitation exceptions.

We used conceptual content analysis 6 to assess public-facing visitor policy content. For anonymity, each policy was assigned an identifier (letters A-M). The initial codebook was generated from professional recommendations (CDC guidelines, state executive order), relevant ethical principles, stakeholders, policy development, dispute processes, screening procedures, and exception type. 6 Visitor policies were single-coded into content categories (HSW), with discrepancies reconciled by JIF and AGS, who engaged in critical reflection, systematically attending to the context of knowledge construction to limit bias. 7 We used the Standards for Reporting

Qualitative Research (SRQR) to present the study design, analysis, and results. 8

All thirteen hospitals had SARS-CoV-2 visitor restriction policies ( Table 1) Numerous local and institutional factors might justifiably motivate institution-specific policy content and enforcement variation. These differences could engender inequity in visitation access and fair appeals processes; further disadvantaging specific populations.

As the policies did not specify stakeholder involvement we could not assess whether and how stakeholders' perspectives informed policies. We recognize that assembling institutional and community stakeholders to inform policies is time-consuming, labor-intensive, and likely infeasible during a rapidly escalating health emergency.

The absence of transparent exception processes could also contribute to disparities, as patients and families enabled to advocate for themselves in such settings differ in kind from those who are not. A centralized exception request process is preferable to unit-based processes, to support equitable application across multiple hospital units or clinics. Accessibility of the exception process supports frontline staff and/or family members struggling to understand visitor restrictions, and facilitates resolution with appropriate triage of exception requests. 5 A major challenge of these policies involves the need for explicit, easily interpreted rules, sensitive to the complexity of familial dynamics and contemporary care delivery across a variety of settings within a given institution. 9 Specification for which visitors are permitted, such as parents or immediate family, could overgeneralize familial structure, excluding individuals important to the patient arbitrarily and unnecessarily; inadvertently creating disparities and inequality for a multi-cultural society with complex family dynamics. 10 While this analysis benefits from a purposive sample representative of Michigan's inpatient hospitals, we recognize limitations including a modest sample size from a single state, and that a snapshot in time of policies does not reflect their likely evolution at each institution.

Assessment of effectiveness or response from patients' or clinicians' perspectives and analyses of implementation experiences are critical next steps. 

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