Intensive care unit staff will not go back to restricted visiting hours

Abstract

Editor—The well-being of patients and their families in the stressful environment of the intensive care unit (ICU) is of prime concern for the modern intensivist and the ICU staff. Several scientific societies strongly recommend a 24 h visiting policy in the ICU, modelling the 21st century ‘patient-centred’ ICU.1Davidson JE Powers K Hedayat KM et al.Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005.Crit Care Med. 2007; 35: 605-622Crossref PubMed Scopus (842) Google Scholar Nevertheless, a great geographical disparity exists; ICUs with liberal visiting hours account for only 70% of ICUs in Sweden, 32% in the USA, 7% in France, and 2% in Italy.2Giannini A Miccinesi G Prandi E Buzzoni C Borreani C ODIN Study Group Partial liberalization of visiting policies and ICU staff: a before-and-after study.Intensive Care Med. 2013; 39: 2180-2187Crossref PubMed Scopus (56) Google Scholar The positive outcome of this measure is well documented from a patient and his or her family's perspective.3Giannini A Garrouste-Orgeas M Latour JM What's new in ICU visiting policies: can we continue to keep the doors closed?.Intensive Care Med. 2014; 40: 730-733Crossref PubMed Scopus (52) Google Scholar However, fewer studies have focused on the staff's perception of such a policy. The most cited drawbacks regarding unrestricted visitation are as follows: fear of care disorganization; loss of control; and fatigue of both patients and staff.4Garrouste-Orgeas M Philippart F Timsit JF et al.Perceptions of a 24-hour visiting policy in the intensive care unit.Crit Care Med. 2008; 36: 30-35Crossref PubMed Scopus (126) Google Scholar, 5Berwick DM Kotagal M Restricted visiting hours in ICUs: time to change.JAMA. 2004; 292: 736-737Crossref PubMed Scopus (150) Google Scholar We aimed to evaluate the evolution of the staff’s perception of this measure over a 3 yr period. Given the initial lack of consensus, this evaluation was a commitment made to our staff, with a return to a restricted visiting policy as a possible result. Our regional trauma centre adopted an unrestricted visiting policy in April 2010. Nurses’ perception of this measure was analysed 9 months (T1) and 3 yr (T2) after the switch. The survey evaluated the staff’s satisfaction with the extension of visiting hours (impact on quality of care and organization, and effect on staff’s relationship with patients’ families) and their wish to go back to a restricted visiting hours policy. It also included staff data on sex, age, and years of ICU experience. It was developed from a survey used in previous research on the subject4Garrouste-Orgeas M Philippart F Timsit JF et al.Perceptions of a 24-hour visiting policy in the intensive care unit.Crit Care Med. 2008; 36: 30-35Crossref PubMed Scopus (126) Google Scholar and was tested prior to investigation. In order to avoid social desirability bias, it was anonymous and self-administered. Statistical analysis was performed using Fisher’s exact test, a Mann–Whitney U-test and a logistic regression. Forty-four staff members responded to each step (participation rate of 72%). There were no differences between the two time points in terms of age, sex, and years of experience of the staff members. All respondents had experienced both restricted and liberal visiting hours in their practice. In the years after this major change, a slight disorganization of care schedule (but not its quality) is still perceived but has diminished thanks to the adaptation of our team. This drawback is largely outweighed by the benefits derived from an improved relationship with patients’ families. With time, fewer staff members wish to return to restricted visiting hours (Table 1). Using logistic regression at T2, with growing experience, the ICU nurses could prevent interference with the organization of the care (odds ratio 0.75; 95% confidence interval 0.59–0.94; P=0.01).Table 1Evolution of staff’s opinion after implementation of a 24 h open visiting policyOpinion9 months after the switch (n=44)3 yr after the switch (n=44)P-valueNegative impact on care quality (%)14110.5Negative impact on care organization (%)57270.01Improved relationship with patients’ families (%)63890.02In favour of returning to a restricted visiting hours policy (%)2320.007 Open table in a new tab We believe that this study may encourage ICU staff and health-care leaders to accept the urgent challenge of liberalizing our visiting policies. None declared. Intensive care unit staff will not go back to restricted visiting hoursBritish Journal of AnaesthesiaVol. 116Issue 4PreviewBritish Journal of Anaesthesia, 2015; 115(2): 319–20, DOI 10.1093/bja/aev240 Full-Text PDF Open Archive