Study supports open and patient-centered visitation guidelines in critical care settings

Watching the clock is becoming an outdated part of visiting a patient in intensive care, as more hospitals ease restrictions and develop more flexible policies focused on the preferences and needs of each patient.

A study published in the January issue of American Journal of Critical Care (AJCC) adds to the growing body of evidence supporting open and patient-centered visitation guidelines.

The article, "Satisfaction With Elimination of all Visitation Restrictions in a Mixed-Profile Intensive Care Unit," reports that eliminating even minimal visitation restrictions led to improved family satisfaction and better nursing perceptions of family satisfaction with the visitation.

The researchers, led by Diane Chapman, RN, BSN, CCRN, surveyed critical care nurses and family members who were visiting patients in an intensive care unit (ICU) at Intermountain Medical Center, Murray, Utah, before and after the implementation of an unrestricted patient visitation policy. The new policy welcomes visitors at all times, limited only by patient preference and clinical status, while the previous policy restricted visits only during a 90-minute period each morning and evening during the shift change for nurses.

The researchers found that the new open visitation policy significantly improved family satisfaction with the visitation hours and waiting room ambiance. Nurses perceived higher visitor satisfaction with the change in policy.

"The term 'visiting hours' is obsolete due to the growing evidence related to the wide-ranging benefits of open access for ICU families," said senior author Samuel M. Brown, MD, MS, director of Intermountain Healthcare's Center for Humanizing Critical Care at Intermountain Medical Center. "Numerous studies have shown that more liberal visitation policies lead to improved family, patient and nurse satisfaction without representing a safety risk. In fact, studies have suggested that patients do better medically when their families are free to accompany them during their ICU stay."

Visitation policies in hospitals have evolved quickly since a 2010 presidential memorandum on the subject and subsequent new regulations for hospitals from the Centers for Medicare and Medicaid Services.

As a result, many hospitals have developed more liberal policies with fewer restrictions, no longer specifying who can visit a patient, the number of visitors at a single time, or when and how long they can stay with the patient.

For the study, the researchers surveyed 103 family members (50 before and 53 after the change in visitation guidelines) and 128 nurses (61 before and 67 after the change in visitation guidelines).