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August 5, 2016

The upside of allowing more visitors in the ICU

Daily Briefing

Some ICUs are changing their policies to allow loved ones more access to patients' bedsides, Lucette Lagnado writes for the Wall Street Journal.

According to a 2013 survey, about 90 percent of ICUs imposed restrictions on visitors, including limits on when they could visit and how long they could stay. Supporters of the restrictions say they protect patients and medical staff from unwanted interruptions.

But some research has shown that ICU patients fare better when they have more access to visitors. A 2015 practice alert published by the American Association of Critical Care Nurses said evidence suggested that a flexible visitation policy "decreases anxiety, confusion, and agitation, reduces cardiovascular complications, decreases length of ICU stay, makes the patient feel more secure, increases patient satisfaction, and increases quality and safety."

How hospitals are working to make the ICU a little less terrifying

Samuel Brown, an ICU physician at Intermountain Medical Center, said more open visitation policies can make the environment more comfortable for patients. "What we have struggled with is maintaining the [ICU's] humanity," he added.

Beverley Johnson, president and CEO of the Institute for Patient- and Family-Centered Care, said visitors can also help the care team in unexpected ways. Hospitals, she said, should view close relatives and loved ones not as visitors but "care partners," adding that if hospitals "viewed them as allies, we would reduce harm."

'When people ask what are your visiting hours, we say we don't have any'

New Jersey-based Valley Hospital used to have a strict ICU visitor policy: Visitors were allowed only between noon and 8 p.m., and family members were not allowed to spend the night with their loved ones. Bettyann Kempin, an assistant VP at Valley who oversees the ICU, said, "We were very strict with the rules."

But now, "when people ask what are your visiting hours, we say we don't have any," Kempin said.

Valley recently implemented an open-visitation policy in the ICU, allowing visitors 24-hour access to patient wards. Pamela Bell, Valley's director of patient and family-centered care, pushed for the change after her personal experience as an ICU visitor in 2014, when her partner was admitted to a different hospital's ICU. Bell had to call the hospital every time she wanted to visit—and as her partner was dying in the ICU, Bell was never allowed to stay overnight.

Inspired by her experience, Bell worked with colleagues at Valley to bring a more liberal visitation policy. At first, nurses were concerned, Kempin said, but they soon warmed to the idea. "[Patients] do better when families are at the bedside holding their hand or being there," Kempin said. "You will see a calm come over them. Their vital signs look a little better."

To accommodate the new influx of visitors, the ICU installed more hand sanitizer dispensers and purchased special sleeper chairs for visitors who spend the night by patients' bedsides. The hospital also installed a system for nurses to summon security staff if a visitor becomes unruly, which Kempin said they haven't had to use (Lagnado, Wall Street Journal, 8/1).

5 myths physicians believe about patient experience

5 myths physicians believe about patient experience

Excellent patient experience is a critical piece of modern medicine, reflected clearly in outcomes. And more than amenities, clean rooms, or quiet during night, the factors that most inflect patient experience all relate to communication and coordination among the care team—factors that physicians are in a unique position to influence.

Clinician-patient communication, leadership of the care team, and support and empathy for the patient across the unit are the most important factors for success, and they're all driven by the physician as the "Influencer in Chief."


More from today's Daily Briefing
  1. Current ArticleThe upside of allowing more visitors in the ICU

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