Researchers try to make ICU less traumatic for patients, families

Intensive care units (ICUs) can be extremely stressful for patients and families. Changes in the way ICUs are run may help mitigate that stress, two new studies suggest.
Researchers looking at the impact of making ICU visiting hours more flexible, and the keeping of ICU diaries by staff and family members, found some interventions could, at the very least, lessen stress for families, according to the two reports published.
“The efforts made by the researchers are admirable,” said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health who was not involved in either study. “But I think this is just a drop in the ocean. The ICU experience is so profoundly disorienting, especially for patients, but also for family members and even, to some extent, the people providing the care.”
The visitation study was originally designed to see if longer visiting hours might help prevent delirium in ICU patients. They didn’t – but they did appear to lower anxiety and depression in relatives.
In that study, the number of visitation hours in 36 adult ICUs in Brazil was expanded from a maximum of 4.5 hours a day to 12 hours a day. From June 2017 to June 2018, 1,685 patients were randomly assigned to the shorter or more flexible visitation schedules.
Average duration of visits was longer in the group with a 12-hour window for visitation: 4.8 hours versus 1.4. And while patient delirium wasn’t reduced with the longer hours, anxiety and depression levels in the family members declined significantly.
“Although a flexible visiting policy for ICUs has been recommended by professional society guidelines, the evidence suggests most ICUs adopt restrictive visitation models, possibly motivated by risks . . . such as disorganization of care, infections and staff burnout,” said the study’s lead author, Dr. Regis Goulart Rosa of Hospital Moinhos de Vento, Porto Alegre, Brazil. “Interestingly these risks were not confirmed in the ICU visits study.”
The longer, flexible, visiting hours offer a host of benefits: “for patients, the benefits of reassurance, emotional support and comfort, for family members the opportunity to help a loved one,” Rosa said in an email.