Effectiveness and Safety of an Extended ICU Visitation Model for Delirium Prevention: A Before and After Study*

Rosa, Régis Goulart; Tonietto, Túlio Frederico; Silva, Daiana Barbosa da; Gutierres, Franciele Aparecida; Ascoli, Aline Maria; Madeira, L; Rutzen, W; Falavigna, Maicon; Robinson, Caroline Cabral; Salluh, Jorge I.; Cavalcanti, Alexandre Biasi; Azevedo, Luciano César Pontes; Cremonese, Rafael Viégas; Haack, Tarissa Ribeiro; Eugênio, Cláudia Severgnini; Dornelles, Aline; Bessel, Marina; Teles, José; Skrobik, Yoanna; Teixeira, Cassiano

doi:10.1097/ccm.0000000000002588

Cited by 154 publications

(150 citation statements)

References 37 publications

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“…The findings of this trial concerning infectious outcomes are consistent with those observed in previous studies, which failed to show an association between flexible ICU visiting hours and infectious complications. 3,6,35 The present results contradict those of a before-and-after study that detected an increased risk of ICU staff burnout after partial liberalization of visiting hours 15 and those of observational studies that showed an increased perception among clinicians of disorganization of care with flexible visitation. 13,14 In the present study, the use of an educational strategy targeting visitors may have improved visitor understanding of the ICU environment and perhaps lessened any negative effect of increased duration of visits on ICU routines and staff workload.…”

Section: Discussioncontrasting

confidence: 99%

“…33 This finding contradicts previous before-andafter studies reporting a lower incidence of delirium with flexible visitation models. 3,4 Potential explanations were considered for the lack of effect of flexible visitation on delirium. The relatively short duration of implementation of flexible visitation may have mitigated the potential benefits of this intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Sample size was calculated based on the results of a beforeand-after study 3 showing an absolute reduction of 10.9% for delirium with flexible visitation. In that study, the incidence of delirium with restricted visitation was 20.5%.…”

Section: Sample Sizementioning

confidence: 99%

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Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit

Rosa

Falavigna²,

Silva

et al. 2019

JAMA

Self Cite

126

122

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IMPORTANCE The effects of intensive care unit (ICU) visiting hours remain uncertain. OBJECTIVE To determine whether a flexible family visitation policy in the ICU reduces the incidence of delirium. DESIGN, SETTING AND PARTICIPANTS Cluster-crossover randomized clinical trial involving patients, family members, and clinicians from 36 adult ICUs with restricted visiting hours (<4.5 hours per day) in Brazil. Participants were recruited from April 2017 to June 2018, with follow-up until July 2018. INTERVENTIONS Flexible visitation (up to 12 hours per day) supported by family education (n = 837 patients, 652 family members, and 435 clinicians) or usual restricted visitation (median, 1.5 hours per day; n = 848 patients, 643 family members, and 391 clinicians). Nineteen ICUs started with flexible visitation, and 17 started with restricted visitation. MAIN OUTCOMES AND MEASURES Primary outcome was incidence of delirium during ICU stay, assessed using the CAM-ICU. Secondary outcomes included ICU-acquired infections for patients; symptoms of anxiety and depression assessed using the HADS (range, 0 [best] to 21 [worst]) for family members; and burnout for ICU staff (Maslach Burnout Inventory). RESULTS Among 1685 patients, 1295 family members, and 826 clinicians enrolled, 1685 patients (100%) (mean age, 58.5 years; 47.2% women), 1060 family members (81.8%) (mean age, 45.2 years; 70.3% women), and 737 clinicians (89.2%) (mean age, 35.5 years; 72.9% women) completed the trial. The mean daily duration of visits was significantly higher with flexible visitation (4.8 vs 1.4 hours; adjusted difference, 3.4 hours [95% CI, 2.8 to 3.9]; P < .001). The incidence of delirium during ICU stay was not significantly different between flexible and restricted visitation (18.9% vs 20.1%; adjusted difference, −1.7% [95% CI, −6.1% to 2.7%]; P = .44). Among 9 prespecified secondary outcomes, 6 did not differ significantly between flexible and restricted visitation, including ICU-acquired infections (3.7% vs 4.5%; adjusted difference, −0.8% [95% CI, −2.1% to 1.0%]; P = .38) and staff burnout (22.0% vs 24.8%; adjusted difference, −3.8% [95% CI, −4.8% to 12.5%]; P = .36). For family members, median anxiety (6.0 vs 7.0; adjusted difference, −1.6 [95% CI, −2.3 to −0.9]; P < .001) and depression scores (4.0 vs 5.0; adjusted difference, −1.2 [95% CI, −2.0 to −0.4]; P = .003) were significantly better with flexible visitation. CONCLUSIONS AND RELEVANCE Among patients in the ICU, a flexible family visitation policy, vs standard restricted visiting hours, did not significantly reduce the incidence of delirium.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit

Rosa

Falavigna²,

Silva

et al. 2019

JAMA

Self Cite

126

122

View full text Add to dashboard Cite

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“…Literature suggests the presence of family and friends may actually soothe and reassure the patient, who experiences an unfamiliar and overstimulated environment. 11 Open visitation may also engender a sense of trust in the families of patients, helping to create a better working environment.…”

Section: Visiting Hours In Neurocritical Care Unitmentioning

confidence: 99%

Organization of a Neurointensive Care Unit

Chavali

Sidiqqi

Rath

2019

Journal of Neuroanaesthesiology and Critical Care

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Although in its infancy as a specialty, neurocritical care is rapidly developing its own niche, with a wide profile of patients-both neurosurgical and those with neurological pathologies. Rapid advances in monitoring technology as well as surgical techniques have led to an increasing number of patients, often presenting with myriad concurrent illnesses, who could be best served if managed by specialist neurointensivists. Neurocritical care units are being developed as free-standing intensive care units in several tertiary care hospitals, and literature regarding their establishment and organization is scant, leading to questions regarding how best to utilize resources to gain maximum benefit. This review aims to outline the challenges that are likely to be faced during establishment of such a unit, and to identify certain issues that are specific to this specialty. AbstractKeywords ► neurointensive care ► organization ► neurosurgery ► neurologyThe first and foremost thing is to develop a policy and define the guidelines for planning an NCCU. This can be

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“…Taking time to provide clear information, listening to them, involving them in decision process and care, giving families full access to the ICU, may help reduce the prevalence of post-traumatic stress disorder [8,9]. Particularly, unrestricted visits in ICU decrease anxiety and psychological disorders, allow for a better adhesion to medical decisions, and improve satisfaction on both impression of safety and quality of care for patients and relatives [6,10].…”

Section: Introductionmentioning

confidence: 99%

Psychological Effects of Remote-only Communication Among Reference Persons of ICU Patients During COVID-19 Pandemic

Cattelan

Castellano²,

Merdji

et al. 2020

Preprint

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Background: During COVID-19 pandemic, visitations have been prohibited in most French ICUs. We aimed to assess psychological effects, for reference persons (RPs), of experiencing remote-only communication with both caregivers and the patient during COVID-19 pandemic.Methods: All RPs of patients referred to ICU for COVID-19 were included. HADS, IES-R, and satisfaction were evaluated at admission, discharge/death and 3 months. At 3 months, an interview with a psychologist provided a qualitative description of RPs’ psychological distress.Results: Eighty-eight RPs were interviewed at patient admission and discharge, and 33 accepted the 3rd month-interview. Prevalence of anxiety and depression symptoms was 65% and 32% respectively at patient admission and 27% and 24% at discharge/death, with a significant decrease between ICU admission and discharge/death (23 [16;31] versus 16 [9;21] points, p<0.01). At 3 months, lower HADS decrease was associated with patient death/continued hospitalization, and/or sleeping disorders in RPs (p<0.01). Despite visit prohibition, 99% RPs felt the patient was safe (9 [7;10]/10 points, Likert-type scale). They also felt confident with caregivers, therapeutic decisions (10 [9;10]/10 points) and satisfied with the manner/frequency information was provided (10 [9;10]/10 points). All RPs stressed the specific-type of “responsibility” associated with being an RP in a remote-only context. The 3 salient themes turned out to be dichotomous variables: positive (9 RPs, 27%) vs. negative (24 RPs, 73%) subjective experience; wide (11 RPs, 33%) vs. narrow (22 RPs, 67%) information diffusion strategies: only a third chose to transmit the information to many relatives. Only 10 RPs (30%) related the situation to a prior traumatic experience.Conclusion: In a distressing situation, remote-only communication allowed RPs to remain involved in decision processes and maintain contact with patient and caregivers.Trial registration: NCT04385121. Registered 12 May 2020. https://clinicaltrials.gov/

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Effectiveness and Safety of an Extended ICU Visitation Model for Delirium Prevention: A Before and After Study*

Abstract: In this medical-surgical ICU, an extended visitation model was associated with reduced occurrence of delirium and shorter length of delirium/coma and ICU stay.

Cited by 154 publications

References 37 publications

Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit

Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit

Organization of a Neurointensive Care Unit

Psychological Effects of Remote-only Communication Among Reference Persons of ICU Patients During COVID-19 Pandemic

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