In a study, patients placed in contact isolation were twice as likely to report perceived problems with care compared with patients without such contact precautions.
Given the increasing influence of patient satisfaction on Medicare reimbursement through the Value-Based Purchasing program, the finding potentially places common infection control practices at odds with hospital interests, the study authors noted.
Contact precautions routinely are used in hospitals to prevent the spread of drug-resistant bacteria between healthcare workers and patients, researchers wrote in the October issue of the journal Infection Control and Hospital Epidemiology.
By creating a physical barrier, contact precautions may modify how healthcare workers interact with patients, thereby affecting patients experience of care, the authors wrote. Use of contact precautions has been associated with decreased healthcare worker visits, increased adverse events and depression among patients.
The researchers used a retrospective cohort study of 528 med/surg patients at the University of Maryland Medical Center, comparing those patients who were placed in contact precautions with those who were not. Each participant underwent a standardized interview at enrollment in the study and on hospital days 3, 7 and 14, or until discharged.
After discharge, the standardized interview and Hospital Consumer Assessment of Healthcare Providers and Systems survey, which factors into Medicare reimbursement through the Value-Based Purchasing program, were administered by telephone for the 88 patients who could be successfully contacted.
Based on the standardized interview results, patients for whom contact precautions were used were more likely to perceive issues with their care, especially as it related to poor coordination of care and a lack of respect for patient preferences.
Importantly, contact precautions did not affect overall HCAHPS scores among the cohort of 88 patients followed-up by phone. However, the authors wrote, “diminished perception of the quality of care can impact patient satisfaction and ultimately hospital reimbursement related to hospital HCAHPS scores.”
This study provides insight into how healthcare workers must balance evidence-based practice with a focus on patient satisfaction, lead author Preeti Mehrotra, MD, of the University of Maryland School of Medicine in Baltimore, said in a news release. “By creating a physical barrier, contact precautions may modify how healthcare workers interact with patients, affecting the patient experience and the perception of how care is delivered.
The authors suggest developing interventions to ensure that patients with contact precautions receive the same quality of care as other patients. Such interventions may include staff education to ensure more patient visits and patient education to help patients understand the reasons for contact precautions. Additionally, the researchers recommend starting a dialogue among healthcare management and workers regarding the positive and negative effects of patient isolation procedures.
Infection Control and Hospital Epidemiology is the the journal of the Society for Healthcare Epidemiology of America. Study: http://www.jstor.org/stable/10.1086/673143.