An environmental scan of visitation policies in Canadian intensive care units during the first wave of the COVID-19 pandemic
Kirsten M. Fiest, Karla D. Krewulak, Carmen Hiploylee, Sean M. Bagshaw, Karen E. A. Burns, Deborah J. Cook, Robert Fowler, Maia S. Kredentser, Daniel J. Niven, Kendiss Olafson, Ken Kuljit S. Parhar, Scott B. Patten, Alison Fox‐Robichaud, Oleksa Rewa, Bram Rochwerg, Krista Spence, Sharon E. Straus, Sean A. Spence, Andrew West, Henry T. Stelfox, Jeanna Parsons Leigh, for the Canadian Critical Care Trials Group
Abstract
PURPOSE: In response to the rapid spread of SARS-CoV-2, hospitals in Canada enacted temporary visitor restrictions to limit the spread of COVID-19 and preserve personal protective equipment supplies. This study describes the extent, variation, and fluctuation of Canadian adult intensive care unit (ICU) visitation policies before and during the first wave of the COVID-19 pandemic. METHODS: We conducted an environmental scan of Canadian hospital visitation policies throughout the first wave of the pandemic. We conducted a two-phased study analyzing both quantitative and qualitative data. RESULTS: We collected 257 documents with reference to visitation policies (preCOVID, 101 [39%]; midCOVID, 71 [28%]; and lateCOVID, 85 [33%]). Of these 257 documents, 38 (15%) were ICU-specific and 70 (27%) referenced the ICU. Most policies during the midCOVID/lateCOVID pandemic period allowed no visitors with specific exceptions (e.g., end-of-life). Framework analysis revealed five overarching themes: 1) reasons for restricted visitation policies; 2) visitation policies and expectations; 3) exceptions to visitation policy; 4) patient and family-centred care; and 5) communication and transparency. CONCLUSIONS: During the first wave of the COVID-19 pandemic, most Canadian hospitals had public-facing visitor restriction policies with specific exception categories, most commonly for patients at end-of-life, patients requiring assistance, or COVID-19 positive patients (varying from not allowed to case-by-case). Further studies are needed to understand the consistency with which visitation policies were operationalized and how they may have impacted patient- and family-centred care.