. 2021 Oct;68(10):1474-1484.

doi: 10.1007/s12630-021-02049-4. Epub 2021 Jun 30.

An environmental scan of visitation policies in Canadian intensive care units during the first wave of the COVID-19 pandemic

Kirsten M Fiest^{1

2

3}, Karla D Krewulak⁴, Carmen Hiploylee⁴, Sean M Bagshaw^{5

6}, Karen E A Burns^{7

8}, Deborah J Cook^{9

10}, Robert A Fowler^{8

11}, Maia S Kredentser¹², Daniel J Niven^{4

13}, Kendiss Olafson¹⁴, Ken Kuljit S Parhar⁴, Scott B Patten¹⁵, Alison E Fox-Robichaud¹⁰, Oleksa G Rewa^{5

6}, Bram Rochwerg^{9

10}, Krista L Spence⁴, Sharon E Straus⁷, Sean Spence⁴, Andrew West¹⁶, Henry T Stelfox^#^{4

13}, Jeanna Parsons Leigh^#^{4

17}; Canadian Critical Care Trials Group

Affiliations

¹ Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada. kmfiest@ucalgary.ca.
² Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada. kmfiest@ucalgary.ca.
³ Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. kmfiest@ucalgary.ca.
⁴ Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
⁵ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada.
⁶ Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
⁷ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
⁸ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
⁹ Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.
¹⁰ Department of Medicine, McMaster University, Hamilton, ON, Canada.
¹¹ Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹² Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada.
¹³ Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
¹⁴ Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
¹⁵ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁶ Canadian Society of Respiratory Therapists, Saint John, NB, Canada.
¹⁷ Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.

^# Contributed equally.

PMID: 34195922
PMCID: PMC8244673
DOI: 10.1007/s12630-021-02049-4

An environmental scan of visitation policies in Canadian intensive care units during the first wave of the COVID-19 pandemic

Kirsten M Fiest et al. Can J Anaesth. 2021 Oct.

. 2021 Oct;68(10):1474-1484.

doi: 10.1007/s12630-021-02049-4. Epub 2021 Jun 30.

Authors

Affiliations

¹ Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada. kmfiest@ucalgary.ca.
² Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada. kmfiest@ucalgary.ca.
³ Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. kmfiest@ucalgary.ca.
⁴ Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
⁵ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada.
⁶ Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
⁷ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
⁸ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
⁹ Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.
¹⁰ Department of Medicine, McMaster University, Hamilton, ON, Canada.
¹¹ Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹² Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada.
¹³ Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
¹⁴ Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
¹⁵ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁶ Canadian Society of Respiratory Therapists, Saint John, NB, Canada.
¹⁷ Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.

^# Contributed equally.

PMID: 34195922
PMCID: PMC8244673
DOI: 10.1007/s12630-021-02049-4

Abstract
in English, French

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.

RéSUMé: OBJECTIF: En réponse à la propagation rapide du SRAS-CoV-2, les hôpitaux du Canada ont adopté des restrictions temporaires pour les visites afin de limiter la propagation de la COVID-19 et de préserver les stocks d’équipements de protection individuelle. Cette étude décrit l’ampleur, les variations et fluctuations des politiques canadiennes concernant les visites aux unités de soins intensifs (USI) pour adultes avant et pendant la première vague de la pandémie de COVID-19. MéTHODE: Nous avons réalisé une étude de milieu des politiques hospitalières canadiennes concernant les visites tout au long de la première vague de la pandémie. Nous avons mené une étude en deux phases analysant des données quantitatives et qualitatives. RéSULTATS: Nous avons recueilli 257 documents faisant référence aux politiques de visites (pré-COVID, 101 [39 %]; mid-COVID, 71 [28 %]; et COVID-tardif, 85 [33 %]). Sur ces 257 documents, 38 (15 %) étaient spécifiques aux USI et 70 (27 %) faisaient référence aux USI. La plupart des politiques au cours de la période pandémique mid-COVID/COVID-tardif ne permettaient aucune visite sauf exception spécifique (p. ex., fin de vie). L’analyse du cadre a révélé cinq thèmes généraux : 1) les raisons des restrictions des politiques de visites; 2) les politiques et attentes en matière de visites; 3) les exceptions aux politiques de visites; 4) les soins aux patients et centrés sur la famille; et 5) la communication et la transparence. CONCLUSION: Au cours de la première vague de la pandémie de COVID-19, la plupart des hôpitaux canadiens avaient des politiques de restriction des visites s’appliquant au public avec des catégories d’exception spécifiques, le plus souvent pour les patients en fin de vie, les patients nécessitant de l’aide ou les patients COVID-positifs (variant d’une interdiction au cas par cas). D’autres études sont nécessaires pour comprendre l’uniformité avec laquelle les politiques de visites ont été mises en œuvre et comment elles ont pu avoir une incidence sur les soins centrés sur le patient et la famille.

Keywords: COVID-19; intensive care unit; policy; visiting policies.

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Figures

**Figure**
Overview of the extent of visitation restrictions at different time points before (preCOVID, N = 101) and during (midCOVID, N = 71; lateCOVID, N = 85) the first wave of the COVID-19 pandemic.

See this image and copyright information in PMC

Comment in

Consequences of visitor restriction policies in the intensive care unit during the COVID-19 pandemic.
Honarmand K, Mehta S. Honarmand K, et al. Can J Anaesth. 2021 Oct;68(10):1465-1470. doi: 10.1007/s12630-021-02048-5. Epub 2021 Jul 1. Can J Anaesth. 2021. PMID: 34212307 Free PMC article. No abstract available.

References

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1. Government of Canada. COVID-19 daily epidemiology update 2021. Available from URL: https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid... (accessed April 2021).
1. Inoue S, Hatakeyama J, Kondo Y, et al. Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg. 2019;6:233–246. doi: 10.1002/ams2.415. - DOI - PMC - PubMed
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1. Davidson JE, Aslakson RA, Long AC, et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med. 2017;45:103–128. doi: 10.1097/CCM.0000000000002169. - DOI - PubMed

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An environmental scan of visitation policies in Canadian intensive care units during the first wave of the COVID-19 pandemic

Affiliations

An environmental scan of visitation policies in Canadian intensive care units during the first wave of the COVID-19 pandemic

Authors

Affiliations

Abstract
in English, French

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References

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Abstract in English, French

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Medical

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Abstract
in English, French