Background: It has long been established that a critical aspect of high-quality patient care is patient-physician communication.1,2 There can be a variety of potential barriers to this communication, and one such barrier might be the use of contact isolation. Indeed, studies have shown that contact isolation does pose the risk of reducing face-to-face time between a physician and patient.3 While of course contact isolation is important and protective to patients,4 it is still important to investigate whether these precautions ultimately affect the quality of patient-physician communications so that potential strategies could be adopted to mitigate any harm.
Methods: This study is a secondary analysis of data from a prospective observational study conducted at a single institution. A trained research assistant observed inpatient medical teaching services to quantify the time spent in each patient’s room (“time at bedside”) on rounds and noted whether the patient was on isolation precautions. Immediately after rounds, the research assistant independently interviewed both the patient and their primary physician to assess key aspects of care: 1) the patient’s main diagnosis, 2) primary concern, 3) planned tests for the day, 4) planned procedures, 5) expected discharge location, and 6) anticipated discharge date. Patient-physician agreement (categorized as agree, partial agree, or not agree) was assessed for each domain. Associations between isolation precautions, time at bedside, and patient-physician agreement were analyzed using the Mann-Whitney U test.
Results: Data was available for 132 patients with an average (median [IQR]) age of 66 years [64.5-76] and length of stay of 4 days [2-10]. Most patients observed on rounds were not on isolation precautions (73.3%). There were no significant associations between patient isolation status times at bedside on rounds (median [IQR], yes: 4.5 [3-7.25] vs. no: 4.5 [3-7], p=0.48), or patient-physician agreement (% completely agree) regarding 1) patient’s diagnosis (isolation: 22.6% vs. no isolation: 35.6%, p=0.37) 2) patient’s main (isolation: 9.4% vs. no isolation: 3.4%, p=0.21) 3) planned tests (isolation: 77.4% vs. no isolation: 66.4%, p=0.62) 4) planned procedures (isolation: 81.1% vs. no isolation: 83.2%, p=0.62) 5) discharge date (isolation: 50.9% vs. no isolation: 45.5%, p=0.29), or 6) discharge location (isolation: 75.5% vs. no isolation: 68.5%, p=0.18)
Conclusions: Perhaps surprisingly, in the analyzed data, there was no significant reduction in time spent at the bedside on rounds or patient-physician agreement based on a patient’s isolation status. A significant limitation of this study is that it is a secondary analysis of an earlier prospective trial. Given the previously established literature showing consistent reductions in time spent at the bedside, it would be worthwhile to reevaluate this question with a dedicated prospective trial.