CORONAVIRUS

With patient outcomes at stake, some Iowa hospitals rethinking visitor bans

Many Iowa hospitals now allow most patients one visitor per day

Terry Shaffer talks Friday to his granddaughter Anna Shaffer, 12, of Rochester, Minn., as Anna and her brother, Luke, an
Terry Shaffer talks Friday to his granddaughter Anna Shaffer, 12, of Rochester, Minn., as Anna and her brother, Luke, and their father, John Shaffer, come to see him at the St. Luke’s Transitional Care Center in northeast Cedar Rapids. (Jim Slosiarek/The Gazette)
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Survivor of heart attacks and cancer, Terry Shaffer has made many trips to the hospital. And his daughter, Stephanie Martinez, usually is his companion.

“Ordinarily, once he’s admitted, I go home and get his walker, CPAP and chargers for his hearing aids and come back and get him set up,” said Martinez, of Cedar Rapids.

But when Shaffer, 78, of Hiawatha, hurt his leg earlier this month and was admitted to UnityPoint Health-St. Luke’s Hospital in Cedar Rapids, Martinez couldn’t come in because it was after visiting hours. When she finally was allowed in the next day, staff hadn’t charged Shaffer’s hearing aids, so he couldn’t communicate with doctors and nurses.

“I don’t fault the hospital for this — they have a lot of patients,” Martinez said. But it’s one example of how visitor restrictions in place during the COVID-19 pandemic can affect a patient’s care.

Starting in mid-April, as Iowa hospitals began treating more COVID-19 patients, most prohibited visitors for adult inpatients unless they were having a baby or were terminally ill. Shortages of protective equipment and uncertainty about how the virus was transmitted made visitor bans seem like the best choice.

Nearly 70 percent of health care providers in the first wave of COVID-19 said their hospital did not allow a visitor or support person for adult inpatients, according to an international survey by the Institute for Patient and Family-Centered Care and the Califoria Pre-Term Birth Initiative of about 500 providers at 394 hospitals.

But it did not take long for providers to see the visitor bans were hurting patient care. Information sharing, family support and family participation in health care planning all took a hit, according to survey respondents.

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“We went overboard,” said Bev Johnson, president and chief executive officer of the institute based in Bethesda, Md. “Nobody should be in the hospital by themselves.”

Since then, many Iowa hospitals — including the hospitals in Cedar Rapids and Iowa City — have revised visitor bans and now allow most patients one visitor per day.

Des Moines hospitals recast their policies last week, allowing adult inpatients to have one designated support person per day visit from 11 a.m. to 7 p.m.

“We’re still ‘no visitors,’ so these individuals are not visitors but they are individuals who are someone who is needed by the patient for their physical and mental well-being,” said Gregg Lagan, spokesman for MercyOne hospitals in Des Moines and West Des Moines.

Support people can include spouses, children or friends, but the patient may designate only two people for approved support visits. MercyOne worked with other Des Moines hospitals to roll out the changes on the same day, Lagan said.

Other Iowa hospitals have continued to prohibit visitors. MercyOne locations in Waterloo, Dubuque and Dyersville, as well as the Virginia Gay Hospital in Vinton, are among hospitals that do not allow adult inpatients to have visitors.

Worse outcomes?

Visitor bans have drawn fire across the country.

The Office for Civil Rights of the U.S. Department of Health and Human Services is investigating a no-visitor policy in Connecticut, NPR reported in May. The probe follows a complaint filed by disability rights groups that say when family and support people are kept out, many disabled and elderly patients can’t make informed medical decisions, NPR reported.

Dr. Ellie Hirshberg is an Intensive Care Unit physician and pediatrician in Utah who has argued against visitor bans in most cases at the hospitals where she works.

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“It’s going to contribute to a national crisis of PTSD and isolationism,” she said, referring to post-traumatic stress disorder. “It enhances the trauma experience of getting hospitalized.”

Hirshberg’s research also indicates patients who don’t have an advocate in the room have more distrust of doctors and nurses and their bounceback rate can be higher once discharged.

In Cedar Rapids, Martinez believes her parents and aunt have had better health outcomes when she’s been able to visit them when they’ve been in the hospital.

Family members can get the patient a glass of water, help him or her to the bathroom or get quicker assistance from a nurse.

“We’ve always been able to be at his side and be that extra hand hospitals just can’t provide,” she said of her father. “There’s no way they could staff up a care center or hospital to do all those things.”

Changing policies

The University of Iowa Hospitals and Clinics in Iowa City decided in July to start allowing adult inpatients to have one masked visitor a day between 1 and 5 p.m.

“We think it’s helpful for the emotional support for patients,” said Suresh Gunasekaran, CEO of UI Hospitals and Clinics.

He said he’s not aware of any complaints filed by families of inpatients, but UIHC did hear from families upset they couldn’t accompany a loved one to a clinic visit or outpatient surgery under the previous policy.

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Before the visitor ban was lifted, UIHC created an ambassador process so patients create a list of who they want health care providers to communicate with, Gunasekaran said. Staff set up times for family members to talk with nurses or doctors, either by phone or FaceTime.

Mercy Medical Center and St. Luke’s also relaxed restrictions in July. Adult inpatients and emergency room patients now may have one visitor at a time between 6 a.m. and 6 p.m. Visitors must be screened, have a badge, wear a mask and stay in the patient’s room most of the time.

“We really see the family as an instrumental part of the care team,” said Peg Bradke, vice president of patient transitions & experience at St. Luke’s. “They are the support person for that patient. They are the ears and eyes for that patient. It’s really important to have that family member here.”

Bradke said visitors to St. Luke’s are following the mask mandate, but sometimes want to have more than one visitor in the room at a time.

Hospital administrators are monitoring COVID-19 rates in their communities to decide whether they need to further restrict visitors.

“If our numbers continue to rise, that could be a tough decision we would have to make,” Bradke said. “We’re trying not to go there.”

Comments: (319) 339-3157; erin.jordan@thegazette.com

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