Patient isolation for infection control and patient experience

Zishan Siddiqui, Sarah Johnson Conway, Mohammed Abusamaan, Amanda Bertram, Stephen Berry, Lisa Allen, Ariella Apfel, Holley Farley, Junya Zhu, Albert W Wu, Daniel Brotman

Research output: Contribution to journalArticle

Abstract

Objective Hospitalized patients placed in isolation due to a carrier state or infection with resistant or highly communicable organisms report higher rates of anxiety and loneliness and have fewer physician encounters, room entries, and vital sign records. We hypothesized that isolation status might adversely impact patient experience as reported through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, particularly regarding communication.Design Retrospective analysis of HCAHPS survey results over 5 years.Setting A 1,165-bed, tertiary-care, academic medical center.Patients Patients on any type of isolation for at least 50% of their stay were the exposure group. Those never in isolation served as controls.Methods Multivariable logistic regression, adjusting for age, race, gender, payer, severity of illness, length of stay and clinical service were used to examine associations between isolation status and top-box experience scores. Dose response to increasing percentage of days in isolation was also analyzed.Results Patients in isolation reported worse experience, primarily with staff responsiveness (help toileting 63% vs 51%; adjusted odds ratio [aOR], 0.77; P =.0009) and overall care (rate hospital 80% vs 73%; aOR, 0.78; P <.0001), but they reported similar experience in other domains. No dose-response effect was observed.Conclusion Isolated patients do not report adverse experience for most aspects of provider communication regarded to be among the most important elements for safety and quality of care. However, patients in isolation had worse experiences with staff responsiveness for time-sensitive needs. The absence of a dose-response effect suggests that isolation status may be a marker for other factors, such as illness severity. Regardless, hospitals should emphasize timely staff response for this population.

Original languageEnglish (US)
Pages (from-to)194-199
Number of pages6
JournalInfection Control and Hospital Epidemiology
Volume40
Issue number2
DOIs
StatePublished - Feb 1 2019

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Patient Isolation
Infection Control
Health Personnel
Odds Ratio
Communication
Delivery of Health Care
Carrier State
Loneliness
Vital Signs
Quality of Health Care
Tertiary Healthcare
Length of Stay
Anxiety
Logistic Models
Physicians
Safety
Infection
Population

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

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Patient isolation for infection control and patient experience. / Siddiqui, Zishan; Johnson Conway, Sarah; Abusamaan, Mohammed; Bertram, Amanda; Berry, Stephen; Allen, Lisa; Apfel, Ariella; Farley, Holley; Zhu, Junya; Wu, Albert W; Brotman, Daniel.

In: Infection Control and Hospital Epidemiology, Vol. 40, No. 2, 01.02.2019, p. 194-199.

Research output: Contribution to journalArticle

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N2 - Objective Hospitalized patients placed in isolation due to a carrier state or infection with resistant or highly communicable organisms report higher rates of anxiety and loneliness and have fewer physician encounters, room entries, and vital sign records. We hypothesized that isolation status might adversely impact patient experience as reported through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, particularly regarding communication.Design Retrospective analysis of HCAHPS survey results over 5 years.Setting A 1,165-bed, tertiary-care, academic medical center.Patients Patients on any type of isolation for at least 50% of their stay were the exposure group. Those never in isolation served as controls.Methods Multivariable logistic regression, adjusting for age, race, gender, payer, severity of illness, length of stay and clinical service were used to examine associations between isolation status and top-box experience scores. Dose response to increasing percentage of days in isolation was also analyzed.Results Patients in isolation reported worse experience, primarily with staff responsiveness (help toileting 63% vs 51%; adjusted odds ratio [aOR], 0.77; P =.0009) and overall care (rate hospital 80% vs 73%; aOR, 0.78; P <.0001), but they reported similar experience in other domains. No dose-response effect was observed.Conclusion Isolated patients do not report adverse experience for most aspects of provider communication regarded to be among the most important elements for safety and quality of care. However, patients in isolation had worse experiences with staff responsiveness for time-sensitive needs. The absence of a dose-response effect suggests that isolation status may be a marker for other factors, such as illness severity. Regardless, hospitals should emphasize timely staff response for this population.

AB - Objective Hospitalized patients placed in isolation due to a carrier state or infection with resistant or highly communicable organisms report higher rates of anxiety and loneliness and have fewer physician encounters, room entries, and vital sign records. We hypothesized that isolation status might adversely impact patient experience as reported through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, particularly regarding communication.Design Retrospective analysis of HCAHPS survey results over 5 years.Setting A 1,165-bed, tertiary-care, academic medical center.Patients Patients on any type of isolation for at least 50% of their stay were the exposure group. Those never in isolation served as controls.Methods Multivariable logistic regression, adjusting for age, race, gender, payer, severity of illness, length of stay and clinical service were used to examine associations between isolation status and top-box experience scores. Dose response to increasing percentage of days in isolation was also analyzed.Results Patients in isolation reported worse experience, primarily with staff responsiveness (help toileting 63% vs 51%; adjusted odds ratio [aOR], 0.77; P =.0009) and overall care (rate hospital 80% vs 73%; aOR, 0.78; P <.0001), but they reported similar experience in other domains. No dose-response effect was observed.Conclusion Isolated patients do not report adverse experience for most aspects of provider communication regarded to be among the most important elements for safety and quality of care. However, patients in isolation had worse experiences with staff responsiveness for time-sensitive needs. The absence of a dose-response effect suggests that isolation status may be a marker for other factors, such as illness severity. Regardless, hospitals should emphasize timely staff response for this population.

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