During the COVID-19 pandemic, hospitals and health systems have had to make changes to balance treating patients with COVID-19 and those in the hospital for other reasons. This shift from routine hospital practice and policies affected the delivery of healthcare to patients in hospitals across Canada. Data from the Canadian Institute for Health Information's Canadian Patient Experiences Inpatient Care survey suggest that despite the changes to hospital procedures during the pandemic, most admitted patients – including those with COVID-19 – had a positive experience. Hospital visitor restrictions, however, did likely impact the involvement of a patient's family and friends. Compared to previous years, fewer patients reported that their family and friends were involved in their care as much as they wanted. This type of patient feedback on care experiences can play a valuable role in highlighting areas of best practice and informing decision making to improve patient care.

Introduction

Since the beginning of the COVID-19 pandemic, hospitals have had to implement a variety of measures to reduce the spread of the virus. These measures – a significant departure from normal hospital practice – have affected the care experiences of patients and their family and friends. Surveying patients after their hospital stay can provide a first look into how the pandemic impacted acute care in-patient experience and is crucial for highlighting areas for potential improvement, as well as best practices (Krist et al. 2017). Findings from this report are similar to those seen at the jurisdictional level (Kemp et al. 2022).

Approach

Survey results containing patient feedback were gathered from the Canadian Institute for Health Information (CIHI) Canadian Patient Experiences Survey on Inpatient Care (CPES-IC). The CPES-IC, a post-discharge survey, was developed by CIHI in collaboration with health system stakeholders and patients to provide standardized reporting of in-patient care from Canadian acute care hospitals (https://www.cihi.ca/sites/default/files/document/patient_expsurvey_inpatient_en.pdf). The survey is administered by Canadian hospitals and jurisdictions, with CIHI supporting the implementation and data submission to the Canadian Patient Experiences Reporting System (CPERS). The results in this article feature 57,883 records (1,053 patients with COVID-19) from CPERS from April 2020 to March 2021 in three provinces: Ontario, Manitoba and Alberta. All results are standardized by age and gender and are adjusted for the type of service a patient received (i.e., medical, surgical or maternity) and the mode in which they responded to the survey (i.e., via mail or telephone, or online).

Key Findings

Most patients had a positive experience during their hospital stay

Changes to hospital procedures because of the pandemic had little impact on overall patient experience. Similar to previous years, 65% of the surveyed patients reported that they had a positive experience during their hospital stay (Figure 1). Males reported more positive experiences than females (67% males vs. 63% females), and experiences during elective hospital stays were more positive than those during urgent hospital stays (68% elective vs. 63% urgent). These positive findings were largely driven by continued good communication between healthcare providers and patients, an important component of which is being treated with dignity and respect.

Fewer patients reported that their family or friends were involved in their care as much as they wanted them to be during the pandemic

Family and friends serve vital roles as patient advocates, providing emotional support and helping patients navigate their care journey. Pandemic measures such as visitor restrictions likely impacted the involvement of a patient's family and friends. In 2020–2021, only 49% of patients reported that their family or friends were involved as much as they wanted them to be in decisions about their care and treatment. This was a large drop from 69% in 2019–2020. In contrast, a patient's own involvement in their care remained largely unchanged during the pandemic; 55% of patients reported that they were involved in their own care as much as they wanted to be (Figure 2).

Most patients with COVID-19 had a positive experience during their hospital stay

Despite care delivery changing throughout hospitals, patients admitted for COVID-19 still reported that they had a positive overall experience during their stay. During the first year of the pandemic, those who were treated for COVID-19 reported a similar overall hospital experience (65%) and involvement of their family and friends (48%) as those who were not treated for COVID-19. The involvement of patients with COVID-19 in their own care decisions and treatment options, however, was different. Only 51% of patients treated for COVID-19 reported being involved as much as they wanted to be in decision making about their own care and treatment options (Figure 3).

Moving Forward

In a limited span of time, hospitals developed novel approaches to address challenges introduced by the COVID-19 pandemic and continued delivering quality care (CIHI 2022; Doyle et al. 2013). The results reported in this article reflect the experience of patients who received care during the pandemic and are limited to what is available in CPERS. Beyond this study, it is just as important to consider the experiences and outcomes of patients who were unable to access care due to delays or cancellations and to also consider whether certain groups were affected more than others. Feedback from patients on their care experiences is crucial for decision making and the planning of services during times of change and radical transformation.

To support future use and uptake of patient experience data for quality improvement alongside other performance measurement indicators, CIHI released results from five patient experience measures on its website "Your Health System: In Depth" in May 2022 (CIHI 2021). These measures were selected for public reporting to reflect patient-, facility- and system-level voices. Moving forward, these data can serve as a valuable tool for sharing best practices and driving improvement in patient-centred care.

Additional results are available at: https://www.cihi.ca/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/impact-of-covid-19-on-patient.

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