A Proposed Framework for Navigating Visitation: Maintaining Patient Safety and Compassionate Care

BACKGROUND: Visitation is a key component to patient-centered care, infection prevention and healthcare operations during the COVID-19 pandemic. Although visitation guidance exists, there is no adaptable published framework among acute care facilities. Objectives include defining key variables and data sources to develop risk matrices, explaining how visitation matrices inform developing a tiering system allowing for fluctuating visitation, and providing an adaptable, dynamic framework to serve as a blueprint whereby infection prevention, patient safety and adherence to guidelines are the focal points. METHODS: An organizational level, multidisciplinary taskforce was developed to address and implement rapidly evolving public health recommendations for visitation. A comprehensive framework was created including matrices, communication pathways and a score-based tiered approach that allowed for flexibility and swift adaptability. This innovative framework weighed patient, visitor and staff safety while aligning with organizational values of compassionate patient-centered care. RESULTS: Two matrices served as risk assessments whereby a risk score was determined. Inpatient matrix variables consisted of disease severity circulating, probability of COVID-19 admissions and census stratified by critical care and medical surgical beds. Emergency Department (ED) matrix criteria were modified to include positive case probability, average daily census, and admission from ED. Within each variable group, the quantitative data were categorized into sub-risk groups and assigned a score from low to high. Tiered guidance resulted from the matrices’ score and included five levels ranging from open visitation to completely closed. Patient care area level guidelines were specified. CONCLUSIONS: Comprehensive tiered guidance is the summation of balancing consistently applied, impartial methodology and the subjective component: continuing to align with providing compassionate care. The taskforce role surpassed policy revisions by creating a nimble mechanism to execute visitation guideline changes while ensuring clear communication. Proposed matrices and tiering system must be documented in the literature for healthcare facilities to adapt and use in future pandemics.