Effective communication in the intensive care unit (ICU) between the medical team and families is crucial, but, due to the COVID-19 pandemic, many hospitals have implemented significant visitation restrictions, limiting the ability of families to be present at bedside in the ICU.
When families are not available for face-to-face discussions, communication must be more intentional and planned, and the use of telephone and video communication has expanded. Evidence is emerging describing the effects of visitation restrictions on the experience of staff, patients and families. A survey being presented at Chest 2021 was conducted on ICU providers to assess communication practices, job satisfaction and burnout during a period of significant visitation restrictions due to COVID-19.
The survey was conducted from December 2020 through January 2021 at several ICUs in the Emory Healthcare system (Atlanta, GA). Surveys were distributed via email to residents, nurse practitioners and physician assistants who may have worked as the primary provider for ICU patients during the preceding 6 months. The visitation policy during that time allowed two visitors only in end-of-life situations where a do not resuscitate order was in place, with rare exceptions.
Topic areas addressed in the survey include:
- Communication practices
- Attitudes about the effect of visitation restrictions on communication and job satisfaction
- Symptoms of burnout (using a validated single-question measure)
Of the 91 providers who completed the study, 61.5% (56/90) of providers reported that most of the ICU patients (>33%) they cared for had COVID-19. When using video to communicate with families, most providers reported using either a unit-based iPad (53.3%, 48/90) or personal device (27.8%, 25/90). Most (90.5%, 76/84) felt video communication was similarly or more effective than telephone. Compared with 1 year prior, 57.9% (51/88) of providers reported they spent more time communicating with families. Most (64.3%, 54/84) felt visitation restrictions were appropriate; 71.4% (60/84) reported these restrictions had a negative impact on job satisfaction. In free text response regarding barriers to effective communication, common themes included inadequate time and the inability for families to be at bedside, and 51.8% (43/83) of providers reported experiencing symptoms of burnout.
“Because families are not present at bedside, restrictive visitation policies have necessitated that communication with families be more intentional and planned than before the COVID-19 pandemic. Understanding the ways these restrictions impact providers and patients can help guide future interventions to improve communication with families and reduce provider burnout,” said Nicole Herbst, MD, lead researcher and Chest 2021 presenter. “Providers are using video communication and are spending more time overall communicating with families than before the COVID-19 pandemic. Even though most providers feel visitation restrictions are appropriate, restrictions have negatively impacted job satisfaction, and providers report high rates of burnout symptoms.”