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Patient isolation for infection control and patient experience

Published online by Cambridge University Press:  18 December 2018

Zishan K. Siddiqui ,
Sarah Johnson Conway ,
Mohammed Abusamaan ,
Amanda Bertram ,
Stephen A. Berry ,
Lisa Allen ,
Ariella Apfel ,
Holley Farley ,
Junya Zhu  and
Albert W. Wu
...Show all authors
Zishan K. Siddiqui
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Sarah Johnson Conway*
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Mohammed Abusamaan
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Amanda Bertram
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Stephen A. Berry
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Lisa Allen
Affiliation:
Johns Hopkins Health System Service Excellence, Johns Hopkins Medicine, Baltimore, Maryland
Ariella Apfel
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Holley Farley
Affiliation:
Hospitalist Unit, Johns Hopkins Hospital, Baltimore, Maryland
Junya Zhu
Affiliation:
Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, Maryland
Albert W. Wu
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Daniel J. Brotman
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Author for correspondence: Sarah Johnson Conway MD, 600 N Wolfe Street, Meyer 8-145, Baltimore, MD 21287. E-mail: sjohn207@jhmi.edu
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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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 2 , February 2019 , pp. 194 - 199
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: These findings were previously presented as a poster at the Society of Hospital Medicine 2018 Annual Conference on April 9, 2018, in Orlando, Florida.

Cite this article: Siddiqui ZK, et al. (2019). Patient isolation for infection control and patient experience. Infection Control & Hospital Epidemiology 2019, 40, 194–199. doi: 10.1017/ice.2018.324

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