Events

In March 2020, the Johns Hopkins Health System instituted a policy to restrict visitors in the hospital and the outpatient clinics to reduce the spread of the COVID-19 virus. The swift focus on patient and staff safety helped to “flatten the curve” and prevent additional cases. When fewer people enter the hospital, there is a greater likelihood that more patients and care providers will stay safe and well. Restricting visitation also allows health care systems to save limited personal protective equipment for hospital staff so that they can care for patients adequately and safely. The policies and procedures put in place were instituted for the safety of patients, families, and staff, but it became clear over the course of the pandemic that patients and their families also suffered as a result of restricting visitors.

Johns Hopkins Medicine holds the philosophy of patient- and family-centered care in high esteem and incorporates it into its mission and strategic plan. It is long recognized that time with loved ones improves recovery and creates a healing environment essential to a patient’s physical and mental well-being. Care Partners advocate for a loved one’s needs and support them in managing their health. Because they know their loved one best, they are uniquely attuned to subtle changes in the patient’s behavior or status. This makes the presence of Care Partners an important strategy for reducing the risk of preventable harm to hospitalized patients.

During the peak of the pandemic, patients suffered not only due to illness but also due to the lack of family presence at the bedside. This had a ripple effect on hospital staff who were distressed by the lack of family presence, especially at critical moments in the patient’s illness. The negative effects of restricted family presence are far-reaching. Patients and family members have been traumatized, and clinicians feel the moral residue from this trauma. Exceptions to the policy have been made to acknowledge individual needs of patients and families, but questions remain as to how decisions to allow visitation are made and for whom.

As the cases of COVID-19 have declined in Maryland, some institutions have begun easing their restricted visitation policies for non-COVID inpatients, same-day surgery, emergency and outpatient appointments. Johns Hopkins Medicine is currently re-evaluating its policy, trying to find the right balance of safety and harm. This Ethics for Lunch will be an opportunity for the hospital community to help shape the discussion about this important aspect of patient- and family-centered care.

Readings: Johns Hopkins Medicine Visitor, Family, Care Partner Restrictions Related to COVID-19

Questions:

1. What are the clinical and ethical issues that may arise for patients, visitors and providers when visitation is restricted?
2. How does the institution weigh the benefits and harms of limiting visitors in the hospital?
3. How are exceptions to the policy determined and are exceptions being made in a uniform and fair manner?
4. What steps can be taken to mitigate the detrimental effects on patients, families and providers when care partners cannot actively participate in the patient’s recuperation?
5. How does the institution decide when it is safe to ease restrictions?

Objectives:

1. Discuss the hospital policy on visitation in response to the COVID-19 pandemic
2. Explore the impact of visitor restrictions on patients and their family members
3. Discuss the moral distress providers have experienced when families have not been able to visit a sick patient
4. Develop a process for engagement with the hospital community to help create policy and procedures for involvement of care partners in the management of hospitalized patients.