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Visiting policies in Italian intensive care units: a nationwide survey

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Abstract

Objective

To investigate visiting policies in Italian intensive care units.

Design and setting

Descriptive survey: a questionnaire was sent to all 303 units of the Italian Group for the Evaluation of Interventions in Intensive Care Medicine.

Results

Response rate was 85% (257/303). All ICUs except one had restricted visiting-hour policies. In five ICUs (2%) visits were not allowed. Median daily visiting time was 60 min (range 15 min–18 h); 55% of ICUs had one daily visiting slot. There were restrictions on number (92% of units) and type (17%) of visitors, and on child visits (69%). Policies were not modified for child patients in 9% of ICUs, nor for a dying patient in 21%. No waiting room was provided by 25% of ICUs. Gowning procedures were compulsory for visitors in 95% of units. In 35% of ICUs visitors were not required to wash their hands. A formal process for revision of visiting policies was underway in 33% of ICUs. In 66% of ICUs informative material on the unit was provided to the family on patient admission. Phone information on the patient was given relatively frequently (often/always, 34% of ICUs). Regional area and volume of admissions significantly influenced visiting hours. A visiting period longer than 60 min/day was significantly associated with more “open” attitudes towards visitors.

Conclusions

Italian ICUs have very restrictive visiting policies, which are only partially liberalized when the patient is dying or is a child. However, one-third of ICUs are rethinking their policies. This survey may contribute towards the liberalization of visiting policies in Italy's ICUs.

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References

  1. Burchardi H (2002) Let's open the door! Intensive Care Med 28:1371–1372

    Article  PubMed  CAS  Google Scholar 

  2. Berwick DM, Kotagal M (2004) Restricted visiting hours in ICUs: time to change. JAMA 292:736–737

    Article  PubMed  CAS  Google Scholar 

  3. Nelson JE, Meier DE, Oei EJ, Nierman DM, Senzel RS, Manfredi PL, Davis SM, Morrison RS (2001) Self-reported symptom experience of critically ill cancer patients receiving intensive care. Crit Care Med 29:277–282

    Article  PubMed  CAS  Google Scholar 

  4. Biancofiore G, Bindi ML, Romanelli AM, Urbani L, Mosca F, Filipponi F (2005) Stress-inducing factors in ICUs: what liver transplant recipients experience and what caregivers perceive. Liver Transpl 11:967–972

    Article  PubMed  Google Scholar 

  5. Molter NC (1979) Needs of relatives of critically ill patients: a descriptive study. Heart Lung 8:332–339

    PubMed  CAS  Google Scholar 

  6. Leske JS (1986) Needs of relatives of critically ill patients: a follow-up. Heart Lung 15:189–193

    PubMed  CAS  Google Scholar 

  7. Mendonca D, Warren NA (1998) Perceived and unmet needs of critical care family members. Crit Care Nurs Q 21:58–67

    PubMed  CAS  Google Scholar 

  8. Bijttebier P, Vanoost S, Delva D, Ferdinande P, Frans E (2001) Needs of relatives of critical care patients: perceptions of relatives, physicians and nurses. Intensive Care Med 27:160–165

    Article  PubMed  CAS  Google Scholar 

  9. Davidson JE, Powers K, Hedayat KM, Tieszen M, Kon AA, Shepard E, Spuhler V, Todres ID, Levy M, Barr J, Ghandi R, Hirsch G, Armstrong D, American College of Critical Care Medicine Task Force 2004–2005, Society of Critical Care Medicine (2007) Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005. Crit Care Med 35:605–622

    Article  PubMed  Google Scholar 

  10. Fumagalli S, Boncinelli L, Lo Nostro A, Valoti P, Baldereschi G, Di Bari M, Ungar A, Baldasseroni S, Geppetti P, Masotti G, Pini R, Marchionni N (2006) Reduced cardiocirculatory complications with unrestrictive visiting policy in an intensive care unit: results from a pilot, randomized trial. Circulation 113:946–952

    Article  PubMed  Google Scholar 

  11. Simon SK, Phillips K, Badalamenti S, Ohlert J, Krumberger J (1997) Current practices regarding visitation policies in critical care units. Am J Crit Care 6:210–217

    PubMed  CAS  Google Scholar 

  12. Roland P, Russell J, Culpepper Richards C, Cox Sullivan S (2001) Visitation in critical care: processes and outcomes of a performance improvement initiative. J Nurs Care Qual 15:18–26

    PubMed  CAS  Google Scholar 

  13. Youngner SJ, Coulton C, Welton R, Juknialis B, Jackson DL (1984) ICU visiting policies. Crit Care Med 12:606–608

    Article  PubMed  CAS  Google Scholar 

  14. Biley FC, Millar BJ, Wilson AM (1993) Issues in intensive care visiting. Intensive Crit Care Nurs 9:75–81

    Article  PubMed  CAS  Google Scholar 

  15. Plowright CI (1996) Revisiting visiting in intensive therapy units. Intensive Crit Care Nurs 12:231–238

    Article  PubMed  CAS  Google Scholar 

  16. Quinio P, Savry C, Deghelt A, Guilloux M, Catineau J, de Tinteniac A (2002) A multicenter survey of visiting policies in French intensive care units. Intensive Care Med 28:1389–1394

    Article  PubMed  Google Scholar 

  17. Knutsson SE, Otterberg CL, Bergbom IL (2004) Visits of children to patients being cared for in adult ICUs: policies, guidelines and recommendations. Intensive Crit Care Nurs 20:264–274

    Article  PubMed  Google Scholar 

  18. Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, Barnoud D, Bleichner G, Bruel C, Choukroun G, Curtis JR, Fieux F, Galliot R, Garrouste-Orgeas M, Georges H, Goldgran-Toledano D, Jourdain M, Loubert G, Reignier J, Saidi F, Souweine B, Vincent F, Barnes NK, Pochard F, Schlemmer B, Azoulay E (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356:469–478

    Article  PubMed  CAS  Google Scholar 

  19. Lee MD, Friedenberg AS, Mukpo DH, Conray K, Palmisciano A, Levy MM (2007) Visiting hours policies in New England intensive care units: strategies for improvement. Crit Care Med 35:497–501

    Article  PubMed  CAS  Google Scholar 

  20. Berti D, Ferdinande P, Moons P (2007) Beliefs and attitudes of intensive care nurses toward visits and open visiting policy. Intensive Care Med 33:1060–1065

    Article  PubMed  Google Scholar 

  21. Bertolini G, Rossi C, Anghileri A, Livigni S, Addis A, Poole D (2007) Use of Drotrecogin alfa (activated) in Italian intensive care units: the results of a nationwide survey. Intensive Care Med 33:426–434

    Article  PubMed  CAS  Google Scholar 

  22. Beccaro M, Costantini M, Giorgi Rossi P, Miccinesi G, Grimaldi M, Bruzzi P; ISDOC Study Group (2006) Actual and preferred place of death of cancer patients. Results from the Italian survey of the dying of cancer (ISDOC). J Epidemiol Community Health 60:412–416

    Article  PubMed  Google Scholar 

  23. Azoulay E, Pochard F, Chevret S, Jourdain M, Bornstain C, Wernet A, Cattaneo I, Annane D, Brun F, Bollaert PE, Zahar JR, Goldgran-Toledano D, Adrie C, Joly LM, Tayoro J, Desmettre T, Pigne E, Parrot A, Sanchez O, Poisson C, Le Gall JR, Schlemmer B, Lemaire F (2002) Impact of a family information leaflet on effectiveness of information provided to family members of intensive care unit patients: a multicenter, prospective, randomized, controlled trial. Am J Respir Crit Care Med 165:438–442

    PubMed  Google Scholar 

  24. Cuttini M, Rebagliato M, Bortoli P, Hansen G, de Leeuw R, Lenoir S, Persson J, Reid M, Schroell M, de Vonderweid U, Kaminski M, Lenard H, Orzalesi M, Saracci R (1999) Parental visiting, communication, and participation in ethical decisions: a comparison of neonatal unit policies in Europe. Arch Dis Child Fetal Neonatal Ed 81:F84–F91

    Article  PubMed  CAS  Google Scholar 

  25. Meyer EC, Kennally KF, Zika-Beres E, Cashore WJ, Oh W (1996) Attitudes about sibling visitation in the neonatal intensive care unit. Arch Pediatr Adolesc Med 150:1021–1026

    PubMed  CAS  Google Scholar 

  26. Plowright C (2006) Just who actually benefits from restricted visiting hours is not clear. Nurs Times 102:12

    PubMed  Google Scholar 

  27. Levy MM (2007) A view from the other side. Crit Care Med 35:603–604

    Article  PubMed  Google Scholar 

  28. Jones C, Skirrow P, Griffiths RD, Humphris G, Ingleby S, Eddleston J, Waldmann C, Gager M (2004) Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Med 30:456–460

    Article  PubMed  Google Scholar 

  29. Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, Annane D, Bleichner G, Bollaert PE, Darmon M, Fassier T, Galliot R, Garrouste-Orgeas M, Goulenok C, Goldgran-Toledano D, Hayon J, Jourdain M, Kaidomar M, Laplace C, Larche J, Liotier J, Papazian L, Poisson C, Reignier J, Saidi F, Schlemmer B; FAMIREA Study Group (2005) Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 171:987–994

    Article  PubMed  Google Scholar 

  30. Slota M, Shearn D, Potersnak K, Haas L (2003) Perspectives on family-centered, flexible visitation in the intensive care unit setting. Crit Care Med 31(Suppl 5):S362–S366

    Article  PubMed  Google Scholar 

  31. Spuhler VJ (2007) Review of literature on open visiting hours in the intensive care unit. Available at: http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Tools/ReviewofLiteratureonOpenVisitingHoursintheIntensiveCareUnit.htm, accessed 2 May

  32. Rogers S (2004) Why can't I visit? The ethics of visitation restrictions—lessons learned from SARS. Crit Care 8:300–302

    Article  PubMed  Google Scholar 

  33. Guzzanti E (1998) L'autorizzazione e l'accreditamento nelle realtà delle strutture ospedaliere e delle tecnologie sanitarie in Italia: considerazioni e proposte. Ricerca per i Servizi Sanitari 2:3–24

    Google Scholar 

  34. Guidelines/Practice Parameters Committee of the American College of Critical Care Medicine, Society of Critical Care Medicine (1995) Guidelines for intensive care unit design. Crit Care Med 23:582–588

    Article  Google Scholar 

  35. Ferdinande P (1997) Recommendations on minimal requirements for intensive care departments. Members of the Task Force of the European Society of Intensive Care Medicine. Intensive Care Med 23:226–232

    Article  PubMed  CAS  Google Scholar 

  36. McClenathan BM, Torrington KG, Uyehara CFT (2002) Family member presence during cardiopulmonary resuscitation: a survey of US and international critical care professionals. Chest 122:2204–2211

    Article  PubMed  Google Scholar 

  37. Edward AE, McGann KA (2002) Steps to reduce nosocomial infections in children. Infect Med 19:414–424

    Google Scholar 

  38. Levine C, Zuckerman C (1999) The trouble with families: toward an ethic of accommodation. Ann Intern Med 130:148–152

    PubMed  CAS  Google Scholar 

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Acknowledgements

We thank GiViTI for their valuable help and all the physicians who participated in this study. We are indebted to P. Quinio (Lorient, France) for allowing us to refer to his questionnaire and to M.M. Levy (Providence, R.I., USA) for his insightful criticisms in reviewing the manuscript.

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via della Commenda 9, 20122, Milan, Italy

    Alberto Giannini & Stefania Leoncino

  2. Unit of Epidemiology, Centro per lo Studio e la Prevenzione Oncologica, Via San Salvi, 12, 50135, Florence, Italy

    Guido Miccinesi

Authors
  1. Alberto Giannini
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  2. Guido Miccinesi
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  3. Stefania Leoncino
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Corresponding author

Correspondence to Alberto Giannini.

Additional information

This study was supported by ABN (Associazione per il Bambino Nefropatico, Milan, Italy).

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Giannini, A., Miccinesi, G. & Leoncino, S. Visiting policies in Italian intensive care units: a nationwide survey. Intensive Care Med 34, 1256–1262 (2008). https://doi.org/10.1007/s00134-008-1037-4

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  • DOI: https://doi.org/10.1007/s00134-008-1037-4

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