Hospital Visitors Research Articles

Restricted family presence for hospitalized surgical patients during the COVID-19 pandemic: How hospital care providers and families navigated ethical tensions and experiences of institutional betrayal

Early in the COVID-19 pandemic restricted family presence in hospitals was a widespread public health intervention to preserve critical resources and mitigate the virus's spread. In this study, we explore the experiences of surgical care providers and family members of hospitalized surgical patients during the period of highly restricted visiting (March 2020 to April 2021) in a large Canadian academic hospital. Thirty-four interviews were completed with hospital providers, family members and members of the hospital's visitor task force. To understand hospital providers' experiences, we highlight the ethical tensions produced by the biomedical and public health ethics frameworks that converged during COVID-19 in hospital providers' bedside practice. Providers grappled with mixed feelings in support of and against restricted visiting, while simultaneously experiencing gaps in resources and care and acting as patient gatekeepers. To understand family members' experiences of communication and care, we use the theory of institutional betrayal to interpret the negative impacts of episodic and systemic communication failures during restricted visiting. Family members of the most vulnerable patients (and patients) experienced short- and long-term effects including anxiety, fear, and refusal of further care. Our analysis draws attention to the complex ways that hospital care providers and families of hospitalized surgical patients sought to establish and reconfigure how trust and patient-centeredness could be achieved under these unprecedented conditions. Practical learnings from this study suggest that if family presence in hospitals must be limited in the future, dedicated personnel for communication and emotional support for patients, families and staff must be prioritized.

Assessing the perceived indoor acoustic environment quality across building occupants in a tertiary-care public hospital in Singapore

Although hospitals are notorious for poor acoustics, the acoustic environment is usually evaluated in silos, or in conjunction with few indoor environmental quality (IEQ) factors. With only anecdotcal evidence, it is important to first establish a holistic baseline perception of the hospital acoustic environment before commissioning costly measurement campaigns. A psychometric questionnaire based on the industry-standard IEQ survey and ISO 12913-2 soundscape standard was administered to examine the perceived indoor acoustic environment quality across major occupant groups (i.e. staff, patients, visitors) in an acute hospital in Singapore. Of the 16 IEQ factors examined, all occupant groups expressed the greatest dissatisfaction with noise levels and sound privacy. Notably, the staff were significantly more dissatisfied than the other groups in terms of sound privacy and overall IEQ. When assessing the overall quality (OQ) and appropriateness (OA) of the acoustic environment, OQ was similarly neutral across all groups, whereas the staff expressed significantly lower OA than both patients and visitors. The dissatisfaction in the acoustic environment could be attributed to the perceived dominance and annoyance of vocal and operational sounds across all occupant groups, as well as the environment set-up with most being housed in cohort rooms. Particularly, the staff were significantly more annoyed with vocal and operational sounds than patients and visitors. This study also yielded evidence that challenges the validity of the 5-item Weinstein noise sensitivity scale when used in an Asian context, as well as the applicability of the perceived affective quality circumplex model in ISO 12913-3 for indoor environments.

The Impact of the COVID-19 Pandemic on Patient Experience in Acute Care Hospitals.

During the COVID-19 pandemic, hospitals and health systems have had to make changes to balance treating patients with COVID-19 and those in the hospital for other reasons. This shift from routine hospital practice and policies affected the delivery of healthcare to patients in hospitals across Canada. Data from the Canadian Institute for Health Information's Canadian Patient Experiences Inpatient Care survey suggest that despite the changes to hospital procedures during the pandemic, most admitted patients - including those with COVID-19 - had a positive experience. Hospital visitor restrictions, however, did likely impact the involvement of a patient's family and friends. Compared to previous years, fewer patients reported that their family and friends were involved in their care as much as they wanted. This type of patient feedback on care experiences can play a valuable role in highlighting areas of best practice and informing decision making to improve patient care.

Identifying Hospital Deserts in Texas Before and During the COVID-19 Outbreak.

In this study, we proposed a GIS-based approach to analyzing hospital visitors from January to June 2019 and January to June 2020 with the goal of revealing significant changes in the visitor demographics. The target dates were chosen to observe the effect of the first wave of COVID-19 on the visitor count in hospitals. The results indicated that American Indian and Pacific Islander groups were the only ones that sometimes showed no shift in visitor levels between the studied years. For 19 of the 28 hospitals in Austin, TX, the average distance traveled to those hospitals from home increased in 2020 compared with 2019. A hospital desert index was devised to identify the areas in which the demand for hospitals is greater than the current hospital supply. The hospital desert index considers the travel time, location, bed supply, and population. The cities located along the outskirts of metropolitan regions and rural towns showed more hospital deserts than dense city centers.

PENGEMBANGAN APLIKASI PELAYANAN ANTRIAN RUMAH SAKIT GATOEL MOJOKERTO BERBASIS ANDROID

Health services are one of the important factors for hospitals. Good and bad services provided will affect the image of the hospital itself. Increased activity in a hospital with limited service facilities will result in queues at the outpatient unit. This happened in Gatoel Mojokerto Hospital. Based on survey that has been conducted, there are 80% of hospital visitors who experience a long queue when registering conventionally and 56% have difficulty receiving information on the doctor's practice schedule. Thus, 94% of patients require an online registration application. The purpose of this study is to make an online registration application to solve patient problems. This research uses waterfall method. In requirement analysis there are 11 functional and 2 non-functional requirements. At the design step, includes the design of use case diagrams, use case scenarios, activity diagrams, sequence diagrams, pseudocode, class diagrams, databases, and interfaces. Then at the implementation step, it produces a database implementation and 12 interface. In the testing step, it is 100% valid on black-box and compatibility. The usability test using SUS resulted in a score of 100 for the admin which was classified as grade A with best imaginable adjective ratings and a score of 88.12 for patients who were classified as grade B with adjective ratings excellent.

A Simulation-Based Cost-Effectiveness Analysis of Severe Acute Respiratory Syndrome Coronavirus 2 Infection Prevention Strategies for Visitors of Healthcare Institutions

ObjectivesThe aim is to quantitatively evaluate different infection prevention strategies in the context of hospital visitor management during pandemics and to provide a decision support system for strategic and operational decisions based on this evaluation. MethodsA simulation-based cost-effectiveness analysis is applied to the data of a university hospital in Southern Germany and published COVID-19 research. The performance of different hospital visitor management strategies is evaluated by several decision-theoretic methods with varying objective functions. ResultsAppropriate visitor restrictions and infection prevention measures can reduce additional infections and costs caused by visitors of healthcare institutions by >90%. The risk of transmission of severe acute respiratory syndrome coronavirus 2 by visitors of terminal care (ie, palliative care) patients can be reduced almost to 0 if appropriate infection prevention measures are implemented. Antigen tests do not seem to be beneficial from both a cost and an effectiveness perspective. ConclusionsHospital visitor management is crucial and effectively prevents infections while maintaining cost-effectiveness. For terminal care patients, visitor restrictions can be omitted if appropriate infection prevention measures are taken. Antigen testing plays a subordinate role, except in the case of a pure focus on additional infections caused by visitors of healthcare institutions. We provide decision support to authorities and hospital visitor managers to identify appropriate visitor restriction and infection prevention strategies for specific local conditions, incidence rates, and objectives.

BSAC Vanguard Series: Behavioural science and antimicrobial resistance.

Antimicrobial resistance could cause 10 million deaths per year by 2050 if no action is taken. While we depend on researchers to find new antimicrobials, reducing the demand for existing ones requires human behaviour change. This article by The Behavioural Insights Team discusses some of the areas with the greatest potential for behavioural interventions to reduce the development of antimicrobial resistance. Three areas are discussed: (i) 'nudging' antimicrobial stewardship (e.g. highlighting comparative over-prescribing was seen to reduce GP antibiotics prescriptions by 3.3%); (ii) promoting good hygiene practices (e.g. placement and salience of hand sanitizer increased hospital visitor compliance from 0.4% to 19.7%); and (iii) leveraging market forces (e.g. front-of-package labelling could increase demand for meat produced with minimal antibiotics, encouraging food production behaviour change).

Lifelong Impact? The Effect of Phototherapy Admission on Future Breastfeeding.

Lifelong Impact? The Effect of Phototherapy Admission on Future Breastfeeding.

“Never let a good crisis go to waste”: Positives from disrupted maternity care in Australia during COVID-19

ObjectiveDue to the COVID-19 pandemic, a number of changes to maternity care were rapidly introduced in all countries, including Australia, to reduce the risk of infection for pregnant women and their care providers. While many studies have reported on the negative effects of these changes, there is a paucity of evidence on factors which women and their providers perceived as positive and useful for future maternity care. DesignData was analysed from the Birth in the time of COVID-19 (BITTOC 2020) study survey. Conventional content analysis and descriptive statistics were used to analyse the data and examine which aspects of COVID-amended care women experienced as positive. Data from women were compared to data from midwives. SettingThis project took place in Australia in 2020-2021. ParticipantsThe survey was distributed to women who gave birth and midwives who worked in Australia during the COVID-19 pandemic (March 2020 onwards). Measurements and findingsWomen reported a variety of positives from their maternity care during COVID-19. These included both care-related factors as well as contextual factors. The most commonly mentioned positives for pregnant and postnatal women were care-related, namely fewer visitors in hospital, having increased access to telehealth services. These were also the most commonly reported positives by midwives. Having midwifery continuity of care models, giving birth at home and having their partner work from home were also highlighted by women as positives. Key conclusionsDespite the negative effect of COVID-19-related restrictions on maternity care, a variety of changes were viewed as positive by both women and midwives, with strong agreement between the two groups. Implications for practiceThese findings provide evidence to support the inclusion of these positive elements of care and ensure that the lessons learned from the pandemic are utilised to improve maternity care in Australia going forward.

Acoustical measurements and user evaluations of three new and existing ICUs

Acoustical measurements were taken in three existing ICUs in a hospital. New ICUs were designed to address acoustical and other issues identified in the three existing ICUs. The results of acoustical measurements made in the new and existing spaces are compared to the results of surveys and focus group discussions with user groups including hospital staff, patients, and visitors. While sounds of individual acoustical events were similar in the new and existing ICUs, the overall sound levels and frequency of sounds decreased in the new ICUs compared to the existing ICUs. This is because the design of the new ICU removed the sounds of nurses speaking at the nurses’ station, medical equipment, and other operations from the patient areas in the new ICU. Overall, the new ICU had a quieter environment for patients, nurses, and visitors as indicated by the acoustical measurements, surveys, and focus group discussions.

Viral Respiratory Infections in Hospitalized Children With Symptomatic Caregivers.

The burden of healthcare-associated viral respiratory infections (HAVRIs) among children is significant. While healthcare workers are often the focus for infection prevention strategies, little is known about the impact of sick caregivers and hospital visitors on the incidence of pediatric HAVRIs. The objective of this descriptive study was to determine the proportion of pediatric HAVRIs following contact with a sick caregiver or visitor. A retrospective chart review was performed of all HAVRIs that occurred between December 2017 and July 2019 in a pediatric tertiary care center. A HAVRI was defined as a laboratory-confirmed respiratory viral illness occurring more than 72 hours after admission. Forty-four HAVRIs occurred in 37 patients during the study, predominantly among patients aged <24 months (n = 32, 72.7%) and with comorbidities (n = 42, 95.5%). For 9 HAVRIs (20.5%), contact with a sick caregiver (n = 8, 18.2%) or visitor (n = 2, 4.5%) in the 7 days before diagnosis was documented. In the 72 hours before HAVRI onset, 18 of the 44 patients (40.9%) were in a single-bed room and 6 of them (33.3%) were under additional precautions. Twelve patients (27.3%) had new or increased oxygen requirements and 4 (9.1%) were transferred to the ICU. There were no associated deaths. Contact with a sick caregiver or visitor is a potential risk factor for acquiring a HAVRI. Our study reinforces the importance of engaging family caregivers in infection prevention and control strategies in pediatric care settings.

Understanding reasons for suboptimal tuberculosis screening in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho.

Lesotho has one of the highest tuberculosis (TB) incidence rates in the world, estimated at 654/100,000 population. However, TB detection remains low, with only 51% of people with TB being diagnosed and treated. The aim of this study was to evaluate implementation of TB screening and identify drivers of suboptimal TB screening in Lesotho. We used a convergent mixed methods study design. We collected data on the number of health facility visits and the number of clients screened for TB during March-August, 2019 from one district hospital and one health center. We conducted interviews and focus group discussions with patients and health workers to elucidate the mechanisms associated with suboptimal screening. Out of an estimated 70,393 visitors to the two health facilities, only 22% of hospital visitors and 48% of health center visitors were asked about TB symptoms. Only 2% of those screened at each facility said that they had TB symptoms, comprising a total of 510 people. Lack of training on tuberculosis screening, overall staff shortages, barriers faced by patients in accessing care, and health care worker mistrust of tuberculosis screening procedures were identified as drivers of suboptimal TB screening. TB screening could be improved by ensuring the availability of well-trained, incentivized, and dedicated screeners at health facilities, and by providing TB screening services in community settings.

Is halal universal? The impact of self-expressive value on halal brand personality, brand tribalism, and loyalty: case of Islamic hospitals

PurposeThe purpose of this study is to examine the antecedents and consequences of halal brand personality in the hospital industry by comparing Muslim and non-Muslim Islamic hospital visitors.Design/methodology/approachOnline questionnaires were distributed to 113 Muslim and 100 non-Muslim Islamic hospital visitors using a purposive proportional sampling technique. The structural equation modelling (SEM) method was used, which is appropriate for complex model testing. SEM was used for both the second-order model and multigroup analysis to compare Muslim and non-Muslim visitors.FindingsSelf-expressive value was significantly affected by halal brand personality. Self-expressive value was a direct antecedent of brand tribalism, which affects brand loyalty. Brand tribalism positively affected brand loyalty. No differences between Muslim and non-Muslim visitors were found, indicating that halal is a universal concept, particularly in the hospital brand personality context.Practical implicationsIslamic hospital marketing managers should empower visitors to build strong brand advocacy. These strategies may lead to new hospital visitors and can be achieved by creating user-generated content distributed via social media. User-generated content is a powerful form of brand advocacy, as non-customers do not view it as marketing.Originality/valueThis study provides insightful empirical contributions to brand literature by showing that halal is a universal and inclusive concept, relatively accepted by consumers regardless of their religious background. This study also offers managerial insights for hospital policymakers in developing strategic programs to strengthen Islamic hospitals' halal brand personalities.

Serologic Survey of IgG Against SARS-CoV-2 Among Hospital Visitors Without a History of SARS-CoV-2 Infection in Tokyo, 2020-2021.

BackgroundTokyo, the capital of Japan, is a densely populated city of >13 million people, so the population is at high risk of epidemic severe acute respiratory coronavirus 2 (SARS-CoV-2) infection. A serologic survey of anti–SARS-CoV-2 IgG would provide valuable data for assessing the city’s SARS-CoV-2 infection status. Therefore, this cross-sectional study estimated the anti–SARS-CoV-2 IgG seroprevalence in Tokyo.MethodsLeftover serum of 23,234 hospital visitors was tested for antibodies against SARS-CoV-2 using an iFlash 3000 chemiluminescence immunoassay analyzer (Shenzhen YHLO Biotech, Shenzhen, China) with an iFlash–SARS-CoV-2 IgG kit (YHLO) and iFlash–SARS-CoV-2 IgG-S1 kit (YHLO). Serum samples with a positive result (≥10 AU/mL) in either of these assays were considered seropositive for anti–SARS-CoV-2 IgG. Participants were randomly selected from patients visiting 14 Tokyo hospitals between September 1, 2020 and March 31, 2021. No participants were diagnosed with coronavirus disease 2019 (COVID-19), and none exhibited COVID-19-related symptoms at the time of blood collection.ResultsThe overall anti–SARS-CoV-2 IgG seroprevalence among all participants was 1.83% (95% confidence interval [CI], 1.66–2.01%). The seroprevalence in March 2021, the most recent month of this study, was 2.70% (95% CI, 2.16–3.34%). After adjusting for population age, sex, and region, the estimated seroprevalence in Tokyo was 3.40%, indicating that 470,778 individuals had a history of SARS-CoV-2 infection.ConclusionsThe estimated number of individuals in Tokyo with a history of SARS-CoV-2 infection was 3.9-fold higher than the number of confirmed cases. Our study enhances understanding of the SARS-CoV-2 epidemic in Tokyo.

Determinant Factors of Nurse's Compliance with Prevention of Application Standards in Health Care Associated Infection (HAIS) Prevention Effort in ICU And UGD Kendari Hospital.

Absctract. Health Care Associated Infection (HAIs) is hospital acquired infections both of which occur in patients when receiving treatment, health workers who work in hospitals and hospital visitors. Standar Precaution created to protect against accidents that can occur. The application of the precaution standard is influenced by compliance. The purpose of knowing the determinants of nurses' adherence to the implementation of Precaution Standards in the prevention of HAIs in the Intensive Care Unit and Emergency Room at the Kendari City Hospital. The type of research used is correlation analytic using the Cross Sectional Study approach. The sample were 37 ICU and IGD room nurses. The sampling technique uses total sampling technique. The variables studied consisted of the dependent variable that is the application of the precaution standard and the independent variables namely knowledge, availability of facilities and motivation. The analysi used is Spearman's rho. The results showed that there is a relationship of knowledge (ρ=0,002; r=0,491), availability of facilities (ρ =0,006; r=0,444) and motivation (ρ =0,009; r=0,425) by applying the precaution standard in the prevention of HAIs. The conclusion of this study is that there is a relationship between knowledge of the availability of facilities and motivation with the application of precaution standards in efforts to prevent HAIs. It is recommended to nurses to increase awareness, understanding, and insight into the quality of nursing services in implementing standard precaution so that the incidence of HAIs can be minimized or prevented.

COVID-19 hospital and emergency department visitor policies in the United States: Impact on persons with cognitive or physical impairment or receiving end-of-life care.

ObjectiveTo characterize the national distribution of COVID‐19 hospital and emergency department visitor restriction policies across the United States, focusing on patients with cognitive or physical impairment or receiving end‐of‐life care.MethodsCross‐sectional study of visitor policies and exceptions, using a nationally representative random sample of EDs and hospitals during the first wave of the COVID‐19 pandemic, by trained study investigators using standardized instrument.ResultsOf the 352 hospitals studied, 326 (93%) had a COVID‐19 hospital‐wide visitor restriction policy and 164 (47%) also had an ED‐specific policy. Hospital‐wide policies were more prevalent at academic than non‐academic (96% vs 90%; P < 0.05) and at urban than rural sites (95% vs 84%; P < 0.001); however, the prevalence of ED‐specific policies did not significantly differ across these site characteristics. Geographic region was not associated with the prevalence of any visitor policies. Among all study sites, only 58% of hospitals reported exceptions for patients receiving end‐of‐life care, 39% for persons with cognitive impairment, and 33% for persons with physical impairment, and only 12% provided policies in non‐English languages. Sites with ED‐specific policies reported even fewer exceptions for patients with cognitive impairment (29%), with physical impairments (24%), or receiving end‐of‐life care (26%).ConclusionAlthough the benefits of visitor policies towards curbing COVID‐19 transmission had not been firmly established, such policies were widespread among US hospitals. Exceptions that permitted family or other caregivers for patients with cognitive or physical impairments or receiving end‐of‐life care were predominantly lacking, as were policies in non‐English languages.

The referral system for specialist dental services at Sefako Makgatho Oral Health Centre: a cross-sectional study

The functioning of various referral systems in service delivery at district level have been described. Aims and Objectives To examine the functioning of referral system for specialist dental services at Sefako Makgatho Oral Health Centre. The prevalence of self-referrals and emergency patients and reasons for referrals were determined. The pattern of referrals for elective treatment at the clinical units was described. Design This was a cross-sectional study Method A structured closed questionnaire was used to collect data related to demographic characteristics, reasons for referrals to the clinic and whether patients were referred by healthcare workers or self-referred. Patients themselves or with the assistance of the research team completed the questionnaire. Data required for classifying patients into emergency and non-emergency was gathered from the service register. The classification was made based on the referral preferences of attending clinicians. Results A substantial proportion of visitors to the hospital were self-referred (71.3%), emergency patients (69.7%). Among referred patients, the most common reason for referrals was for specialist oral and maxillofacial surgical services. The majority (64.7%) of hospital visitors received elective treatment referrals, 48.9% of which were for general dentistry.Conclusion The prevalence of self-referrals by emergency patients is extremely high.

Impact of COVID-19 on Radiology Trainee Safety, Education, and Wellness: Challenges Experienced and Proposed Solutions for the Future.

Impact of COVID-19 on Radiology Trainee Safety, Education, and Wellness: Challenges Experienced and Proposed Solutions for the Future.

ANALYSIS OF DOMINANT FACTORS AFFECTING THE IMPLEMENTATION OF COVID-19 SCREENING AT TGK CHIK DITIRO SIGLI HOSPITAL

Introduction : The implementation of the Covid 19 screening is very important to control the spread of the Corona Virus which is increasingly rampant. Screening is the first step that must be carried out on all suspected people including every hospital visitor. In principle, all visitors should be screened even if they are asymptomatic because some infected cases do not show any symptoms. The purpose of the study: to analyze the dominant factors that influence the implementation of Covid 19 screening at Tgk Chik Ditiro Sigli Hospital. The stages of this research are starting from the preparation, implementation, and analysis stages. The design used is a quantitative design with a causal association approach, which is to see a causal relationship. The method of data collection was done by distributing questionnaires and then analyzed using multiple linear regression statistical analysis. The next step is to present the data and draw conclusions. The results of this study were found that the factors of officers, patients, PPE, policies, and the environment affected the implementation of the Covid 19 screening with p-values of 0.001, 0.000, 0.002, 0.001, and 0.002, respectively. The most dominant factor influencing is the officer factor with the results of univariate analysis, namely Y = 19,877 + 0,091X1 + 0,045X2 + 0,080X3 + 0,043X4 + 0,072X5. This study concludes that the officer factor is the most dominant factor influencing the implementation of Covid 19 screening.

Evaluating Pediatric Families' Understanding of and Reactions to COVID-19 Visitor Restrictions.

The COVID-19 pandemic led to changes in hospital visitor policies and little is known about the impact on patients and their families. This study evaluated families’ understanding of and reactions to COVID-19-related visitor restriction policy at an academic children's hospital. We conducted a cross-sectional study with families of patients admitted to the pediatric ICU and general pediatric wards from September 2020 to November 2020. Parents (n = 73) completed a survey assessing communication, understanding of and satisfaction with visitor policies, strategies of coping with illness, and Hospital Anxiety and Depression Scale (HADS) scores. Descriptive analyses were performed to summarize data. Associations between outcomes and participant characteristics were examined. A majority (88%) of respondents reported hospital visitor restrictions were explained, usually in-person (94%), and understood the policy “very well” (68%), but none correctly identified all reasons for visitation restrictions. Eighty-five percent reported other family/friends would have visited, however minority families were more likely to report they would have had fewer visitors if restrictions were not in place (P = 0.0385). A majority (69%) were satisfied with how the hospital handled visitor polices, and parents of older children were more satisfied (P < .0001). HADS scores were consistent with anxiety or depression in about half of respondents. Forty percent of respondents believed restrictions affected their own and their child's ability to cope during hospitalization. Parents expressed satisfaction with and understanding of visitor policies but did not understand the rationale for visitor restrictions. Visitor restrictions may impact parental and child coping and mental health outcomes.