Social Distancing: Communication With Patients Families

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Table of Contents

Purpose
Policy
Areas of Responsibility
Procedures for Implementation
Evaluation of Outcome
Responsibilities
Controls
References

Purpose

Recent events surrounding the COVID-19 pandemic as well as frequent natural disasters have forced change in the workflow of medical facilities. The necessity to maintain social distancing, preserve resources and streamline workflow has severely limited the ability for visitation for families, loved ones, or caretakers of admitted or hospitalized patients. However, modern health practices encourage and require providing information and awareness to the patient’s families. The purpose of this policy is to provide guidelines on implementation of a process to maintain communication with families of hospitalized patients, during periods of social distancing, natural disasters, pandemics, and other situations where visitation is prohibited or discouraged.

Policy

Family-centered care which allows for families, patients and the healthcare team to collaborate is threatened during events that limit visitation. Typical strategies which typically include open family presence by the bedside and structured communication and education are lacking, which may not prepare families for critical decision-making roles and cause anxiety. Restrictions on family presence, should NOT undermine adherence to family-centered care (Hart et al., 2020). Facilities should apply alternatives for direct communication between patients, families, and healthcare teams using remote communications technology including but not limited to telephone or internet connection which will allow for audio or video calls (CDC, 2020). The objective is to enable communication and provision of telehealth through remote communications with the goals of 1) establishing collaboration between family members and healthcare team; 2) maintaining family integrity; and 3) respecting the role of family members as care partners (Hart et al., 2020).

Areas of Responsibility

Admission

Patients and families should be made aware of restrictive policies on visitation.
Public-facing material should be available on the facility website regarding remote communication policies, establishing communication, and link to finding places with internet connection/software for communication if not available (important for certain low-income or rural communities).
Inpatient clinical teams should develop a communication plan with patients and family members after admission. Clinicians are encouraged to identify and mitigate barriers to communication.
Primary family contact should be established who is ideally the legal health care decision-maker in case the patient deteriorates (Hart et al., 2020).

Hospitalization

Structured and predictable communication should occur based on a planned schedule, at least once per 3 days (preferably daily). Proactive outreach is encouraged.
Videoconferencing is preferable as it improves emotional connection through facial expressions and nonverbal communication.
Clinical staff should be unburdened from non-essential training and documentation responsibilities to provide time for telehealth education and communication with families.
Care delivery and the requirement for communication may result in reinterpretation of roles within multidisciplinary teams as human resources are scarce (Hart et al., 2020).

Effective Clinical Communication

Demonstrate listening skills, show empathy, and be informative.
Compensate lack of physical non-verbal cues due to communication gaps with other nonverbal tools such as tone and inflection of voice.
Remain reasoned and truthful, as families perceive not only clinical results but attitudes and psychological support from care teams (Marra et al., 2020).

Procedures for Implementation

The U.S. allows the use of technologies, including public and commercial platforms which may not be fully compliant with HIPAA rules during public health (Hart et al., 2020).
Timely and clear communication allows to manage expectations and build family confidence while reducing anxiety and vulnerability.
Integration of portable workstations with video conferencing software and other communications to utilize while making healthcare decisions with patients and families (Rosenbluth et al., 2020).
Integrating telehealth technologies and education, including for staff, to utilize in the workflow process.
Enhancing communication skills in clinical staff to account for telehealth communication and challenges surrounding guiding and informing families virtually, particularly in contexts of end-of-life care (Back et al., 2020).

Evaluation of Outcome

Communication logs were kept, with an objective to contact patient families at least once per three days of hospitalization. Failed audio or video communication should be followed up with email or text messaging.
Supervisor observation of clinician using effective clinical communication with families and patients.
Family and patient satisfaction surveys evaluating frequency and quality of virtual communication.

Responsibilities

Clinical staff providing healthcare for patients is expected to make efforts to maintain communication with family members or any other potential caretakers when it is safe and appropriate to do so without interference with medical care. The policy is meant to serve as a guideline and in the context of emergencies or pandemics, it is recognized that communication may be disrupted or scarce. It is the responsibility of the hospital administration and supervisors to provide the equipment and time necessary for clinicians to engage in relevant communication with families regarding medical care decisions or status updates regarding the patient. Hospital IT staff is responsible for preparing the necessary equipment, including the installation of hardware and software at workstations as well as ensuring stability and security of connectivity to the best extent possible.

Controls

This policy is expected to remain in place for the duration of COVID-19 restrictions which limit or prohibit visitation to medical facilities. The hospital administration will review the policy every three months to assess its effectiveness. Going forward this policy is expected to be implemented periodically and should be reviewed before implementation in the context of major human or natural disasters.

References

Back, A., Tulsky, J. A., & Arnold, R. M. (2020). Communication skills in the age of COVID-19. Annals of Internal Medicine, 172(11), 759-760.

CDC. (2020). Management of visitors to healthcare facilities in the context of COVID-19: non-US healthcare settings. Web.

Hart, J. L., Turnbull, A. E., Oppenheim, I. M., & Courtright, K. R. (2020). Family-centered care during the COVID-19 era. Journal of Pain and Symptom Management, 60(2), 93-97. Web.

Marra, A., Buonanno, P., Vargas, M., Iacovazzo, C., Ely, E. W., & Servillo, G. (2020). How COVID-19 pandemic changed our communication with families: losing nonverbal cues. Critical Care, 24(1). Web.

Rosenbluth, G., Good, B. P., Litterer, K. P., Markle, P., Baird, J. D., Khan, A., Landrigan, C. P., Spector, N. D., & Patel, S. J. (2020). Communicating effectively with hospitalized patients and families during the COVID-19 pandemic.Journal of Hospital Medicine, 15(7), 440–442. Web.

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