Visitation policies and practices in US ICUs

Abstract

IntroductionPrior reports suggest that restrictive ICU visitation policies can negatively impact patients and their loved ones. However, visitation practices in US ICUs, and the hospital factors associated with them, are not well described.MethodsA telephone survey was made of ICUs, stratified by US region and hospital type (community, federal, or university), between 2008 and 2009. Hospital characteristics were self-reported and included the hospitals' bed number, critical care unit number, and presence of ICU leadership. Hospital and ICU visitation restrictions were based on five criteria: visiting hours; visit duration; number of visitors; age of visitors; and membership in the patient's immediate family. Hospitals or ICUs without restrictions had open visitation policies; those with any restriction had restrictive policies.ResultsThe study surveyed 606 hospitals in the Northeast (17.0%), Midwest (26.2%), South (36.6%), and West (20.1%) regions; most were community hospitals (n = 401, 66.2%). The mean hospital size was 239 ± 217 beds; the mean percentage of ICU beds was 11.6% ± 13.4%. Hospitals often had restrictive hospital (n = 463, 76.4%) and ICU (n = 543, 89.6%) visitation policies. Many ICUs had ≥ 3 restrictions (n = 375; 61.9%), most commonly related to visiting hours and visitor number or age. Nearly all ICUs allowed visitation exceptions (n = 474; 94.8%). ICUs with open policies were more common in hospitals with < 150 beds. Among restrictive ICUs, the bed size, hospital type, number of critical care units, and ICU leadership were not associated with the number of restrictions. On average, hospitals in the Midwest had the least restrictive policies, while those in the Northeast had the most restrictive.ConclusionIn 2008 the overwhelming majority of US ICUs in this study had restrictive visitation policies. Wide variability in visitation policies suggests that further study into the impact of ICU visitations on care and outcomes remains necessary to standardize practice.

Traditional/Restrictive vs Patient-Centered Intensive Care Unit Visitation: Perceptions of Patients' Family Members, Physicians, and Nurses

“…Participants T raditional, non-patient-centered environments prevent patients' families from visiting their loved ones except during predesignated, time-limited periods interspersed throughout a long hospital day. 1,2 Dissatisfaction with this traditional visitation paradigm has pushed families to become more involved in their loved one's care with a greater focus on the transparency of health-care quality. [3][4][5][6][7][8][9][10][11] This focus is evidenced by calls to action for hospitals to examine their current intensive care unit (ICU) visitation practices [12][13][14][15][16][17][18][19] and to try entirely open, nonrestrictive ICU visiting, labeling any visiting restrictions as a relic, unnecessary, and potentially harmful to the patient's safety.…”

Visita aberta em uti adulto: utopia ou realidade?

“…4 Em países da América do Norte e da Europa, a política de visitação já vem sendo abordada com maior destaque; porém, a maioria das UTIs localizadas nos Estados Unidos possui políticas de visitação restritas. 5,6 Um estudo realizado na Holanda, com o objetivo de avaliar as políticas de visitação nas UTIs, evidenciou que 85% ainda apresentam visitação restritiva. 7 Outro estudo realizado na Nova Inglaterra, mostrou que das 171 UTIs avaliadas, somente 32% apresentaram políticas de visitação aberta ou ampliada.…”

“…As abordagens em relação às visitas devem ser individualizadas em cada unidade, pois precisam atender às necessidades dos pacientes, familiares e profissionais da saúde, ou seja, cada UTI adulto deve adotar a política de visitas que melhor se adapte à realidade local. 4,5,10,17 Em relação à preferência dos pacientes pelo período de visitação, sabe-se que é importante avaliar os benefícios que a presença da família, durante um período ampliado, pode causar ao paciente, e se a presença do familiar irá trazer benefício para o doente ou interferir nos procedimentos em determinados momentos, ou seja, o processo de comunicação deve ser eficaz para que seja prestada uma assistência com maior qualidade. Os pacientes preferem que a visita seja flexível e que seja acompanhada por pessoa próxima, mas também necessitam de tempo de descanso durante o período de visitas.…”

Dominant Strategies of Patient Visiting in Selected Intensive Care Units in Iran

“…The importance of visiting is to the extent that health care authorities and even political leaders in some cases recommend flexible visiting to medical systems (11).…”