Family Visitation Policies in the ICU and Delirium—Reply

Abstract

public health care system is 1.6% vs 12% for US private insurers and 13% for Canadian private insurers who sell coverage for items (eg, prescription drugs) not included in the public benefit package. 6 Contending with multiple insurers also raises hospitals' and physicians' overhead costs, which act as a surcharge on the fees they must charge. US hospitals' overhead is twice that of their Canadian counterparts, which (similar to fire departments) receive global, lump-sum budgets, obviating the need to attribute costs to and bill for each patient. Canada's physicians have been spared much of the burden (and cost) of contending with a multiplicity of billing rules, documentation requirements, copayments, formularies, and referral networks.For the United States, the administrative savings of a Canada-like system could potentially shift about $500 billion annually from bureaucracy to patient care. That infusion of clinical funding would make universal coverage affordable, without the queues that bedevil Canada or the long waits for care that millions of uninsured and underinsured individuals in the United States now endure.

Family Presence and Visitation Practices in Latin American PICUs: An International Survey

“…10 More recently, a large randomized trial involving 1,685 patients from 151 Brazilian ICUs sought to answer whether a more flexible visitation practice (up to 12 hours per day) reduced the incidence of delirium compared with standard practice (visitation up to 4.5 hours per day). 11 Although this study failed to demonstrate that flexible visitation reduced the incidence of delirium, it led to lower anxiety and depression scores in family members. 11 The lack of strong evidence supporting open family visitation policies might explain why current adult ICU visitation practices are still predominantly restrictive.…”

“…11 Although this study failed to demonstrate that flexible visitation reduced the incidence of delirium, it led to lower anxiety and depression scores in family members. 11 The lack of strong evidence supporting open family visitation policies might explain why current adult ICU visitation practices are still predominantly restrictive. These restrictions range from prohibition of visits up to only a few hours a day, and occur across varied sociocultural contexts, such as in Belgium, 12 Brazil, 13 France, 14 Iran, 15 Spain, 16 and in the United States, 17 although significant practice variability exists.…”

Psychological Consequences of Admission to the ICU

“…In this issue of JAMA , 2 reports focus on the psychological well-being of patients in the ICU and their families. Rosa and colleagues report findings from a cluster crossover randomized clinical trial in 36 Brazilian ICUs that examined the effect of a flexible family visiting model (up to 12 h/d) compared with usual practice of a restrictive visiting model (median of 1.5 h/d) on the incidence of delirium. During the intervention phase, family members also attended a structured meeting and were provided education on the ICU environment, common procedures, the multidisciplinary team, and delirium; received an informational brochure; and were given access to a website that provides information about critical illness, care processes, and bedside visits.…”

Kinder als besuchende Angehörige auf der Erwachsenenintensivstation – Go oder No-Go?

“…Die Regelungen zu Besuchszeiten und -bedingungen sind auf Intensivstationen heterogen. Während es in der internationalen Literatur bereits viele Erkenntnisse für familienzentrierte Betreuung gibt 2 – 8 , werden Kinder und Jugendliche (definiert als „Kinder“ im Alter von 0–17 Jahren) als Besuchende oft nicht in diese Studien einbezogen, insbesondere wenn es um ihre Rolle als Besuchende geht. Kinder und Jugendliche gehören jedoch zur Familie dazu.…”