Open visiting policies in Intensive Care Units may not affect consent to organ donation

Abstract

Open Intensive Care Unit’s (ICU’s) visiting policies have been introduced since 19841Youngner SJ Coulton C Welton R Juknialis B Jackson DL ICU visiting policies.Crit Care Med. 1984; 12: 606-608Crossref PubMed Scopus (38) Google Scholar contributing to the humanization of the care of patients and families.2Cappellini E Bambi S Lucchini A Milanesio E Open intensive care units: a global challenge for patients, relatives, and critical care teams.Dimens Crit Care Nurs. 2014; 33: 181-193Crossref PubMed Scopus (35) Google Scholar, 3Giannini A Open intensive care units: the case in favour.Minerva Anestesiol. 2007; 73: 299-305PubMed Google Scholar The expected effects of open ICU policies include increased physical contact between relatives and patients and improved communication with the ICU staff. There is still a lack of strong evidence of the positive effects of open ICUs on the overall prognosis of patients, but it is believed that open ICUs policies, and family presence during cardiopulmonary resuscitation,4Peris A Bambi S Family presence during cardiopulmonary resuscitation could make more natural organ donation.Int Emerg Nurs. 2014; 22: 234Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar could improve the perception of both patients and relatives about the quality of ICU stay,2Cappellini E Bambi S Lucchini A Milanesio E Open intensive care units: a global challenge for patients, relatives, and critical care teams.Dimens Crit Care Nurs. 2014; 33: 181-193Crossref PubMed Scopus (35) Google Scholar which in turn could affect positively the consent to organ donation (OD). On this basis, we assumed that the liberalization of visiting policies could reduce the opposition rates to OD from the relatives of brain dead patients (BDPs). After approval from the Ethics Committee, we conducted a descriptive study to determine the status of implementation of open visiting policies in the ICUs of the Tuscany Region, where 3.800.000 people live. A questionnaire was developed by a focus group of five researchers working in ICUs. The retrospective phase of the study was conducted through the registry data of the Regional Transplant Centre, related to procurement activities from 2004 to 2013, to determine the number of OD oppositions from the families of BDPs. All data were analysed in anonymous fashion. We sent 44 questionnaires by email, and 21 were returned (48%). 15 ICUs (71.4%) stated that they had open visiting policies. 12 (86%) adults ICUs were open, while only one of the two pediatric ICUs and 2 (40%) mixed patients ICUs have adopted open visiting policies (P=0.118). 50% of open ICUs implemented their liberalized visiting policies from 2011 to 2013. The mean visiting time of relatives between open ICUs and not open ICUs was significantly different (mean (SD) 10.9 (6.5) h and 4 (4) h respectively; t-test 2.370, P=0.029). We retrieved data on 877 BDPs. We did not find any significant difference between the weighted average percentage rates of OD oppositions from the current and the previous ‘not open’ status ICUs and the open ICUs (25.3% and 27.6% respectively; χ2 test 0.2310, P=0.6308), from the actual 6 ‘not open’ ICUs and the 9 open ICUs (27.6% and 23.3%, respectively; χ2 test 0.6580, P=0.4173), and from university hospitals and non-university hospitals’ open ICUs (26% and 34%, respectively; χ2 test 1.524, P=0.217). At the present we cannot show any association between open visiting policies in ICU and the relatives’ oppositions to OD. Therefore, despite of our belief in the ethical force of opening ICUs, these results suggest that there is still not a clear awareness about ‘how’ we′re opening our organizations to the relatives. The lack of a unique interpretation for the concept of ‘open visiting policies’2Cappellini E Bambi S Lucchini A Milanesio E Open intensive care units: a global challenge for patients, relatives, and critical care teams.Dimens Crit Care Nurs. 2014; 33: 181-193Crossref PubMed Scopus (35) Google Scholar could have influenced the results of this study, because we performed data analysis according to the subjective statement of ‘open’ or ‘not open’ given by every single ICU that we surveyed. The low number of respondents probably affected the power of statistical analysis. Almost half of the open ICUs could not undergo comparative analysis about the percentage of OD, before and after the implementation of open visiting policies, as a result of the scant sample of the ‘open’ period. The reason was because of the very recent change of visiting policies in most ICUs. It could be appropriate to replicate this study in at least 5 yrs, to reach sufficient comparable proportions of OD between the periods before and after opening visiting policies in ICUs. None declared.