A new study reveals that patients kept in isolation receive inferior care. When compared to patients in normal wards, they were twice as likely to experience preventable adverse outcomes.
“Patient isolation procedures are indispensable to dealing with commutable disorders,” says Professor Donald Redelmeier of U of T’s Department of Medicine. He conducted the study alongside Dr. Henry Thomas Stelfox and Professor David Bates of Harvard University.
The study dealt with patients who contracted pneumonia, wound infections and heart problems. Four hundred and fifty adult patients were examined at Sunnybrook and Women’s College Health Sciences Center in Toronto and at Brigham and Women’s Hospital in Boston, Massachusetts.
The study was published in the October 8 issue of the Journal of the American Medical Association.
The care of isolated patients was compared with that of regular patients who had similar health conditions.
Isolated patients were not given their medication or food on time. Their call buttons were not responded to promptly. They experienced specific complications such as falls and bedsores.
Dr. Stelfox speculates that two aspects contributed to the disregard of the patients. “Out of sight means out of mind,” says Dr. Stelfox, “and the impediment to see them.”
“Human beings tend to take the path of least resistance,” reflects Professor Redelmeier.
Due to the effort and time involved for health care workers required to dress in protective equipment, “isolation puts barriers between patients and health care workers,” says Dr. Stelfox.
A situation that illustrates the difficulties hospitals face in caring for isolated patients is when an isolated patient needs a CT scan. Health care workers accompanying the patient must put on gowns and gloves. The CT scan room workers also need to wear protective gear. After the procedure, the entire CT scanning room needs to be disinfected. “A huge additional effort is required,” comments Dr. Stelfox.
Fortunately, simple solutions can be implemented to increase the quality of living for isolated patients. Professor Redelmeier suggests free phones and TV’s be provided in all isolation rooms, resulting in improved compliance and reduced boredom.
Additional coverage is also crucial. Hospitals should employ a registered nurse whose sole duty is to make rounds on isolated patients. “Now,” compares Dr. Stelfox, “multiple nurses in multiple wards are dealing with them.”
Dr. Stelfox believes more research is needed. “Patient isolation is important, no question about it,” he remarks.
The SARS epidemic that hit Toronto confirms the importance of isolating patients. “Patient isolation was the single most important technique for dealing with the SARS epidemic,” comments Professor Redelmeier. “Medication was not helpful.”
Nonetheless, the results of this recent study are already having an impact on the care of current isolated patients. “In my hospital,” remarks Redelmeier, “we have instituted new policies.” Dedicated nurse practitioners are provided for the patients. “Other hospitals should follow,” advises Redelmeier.
