Flexible ICU Visiting Hours Tied to Less Delirium and Anxiety

When intensive care units (ICUs) have flexible visiting hours that allow families to spend more time at the bedside, patients may be less likely to suffer delirium or severe anxiety, a research review suggests.

Most ICUs have restrictive visiting policies, often driven by a concern that families lingering in patient rooms might increase the risk of infections, disorganized care, or longer hospital stays, researchers note in the journal Critical Care Medicine.

But data pooled from seven previous studies of ICU patients show no connection between flexible visitor policies and patients’ risk of death, infections, or longer hospital stays, the researchers found.

Plus, patients in ICUs with flexible visiting policies were 61 percent less likely to develop delirium and also less likely to experience severe anxiety.

“ICU admission is a very stressful event for patients, and it is associated with anxiety symptoms and acute clinical conditions, and the ICU environment predisposes patients to delirium,” said study leader Antonio Paulo Nassar Jr. of the Camargo Cancer Center in Sao Paulo, Brazil.

Previous research has found that simple measures to help maintain hospital patients’ sense of orientation and make them comfortable in their surroundings, such as the presence of a family member, may reduce the risk of delirium. But it’s not clear whether this also holds true in the ICU, where delirium is much more common.

“Our review suggests these measures are also associated with decreased rates of delirium in ICU,” Nassar said by email.

In one respect, however, concerns about liberal visitor policies may be justified, the results suggest.

One study in the analysis, for example, found that nurse burnout increased after families were permitted to spend more time visiting ICU patients.

“The presence of a family member for long periods may increase health care professionals’ workload, families may bring additional demands and frequent questions, and family members can also be very anxious which can compromise nurses’ and doctors’ work in ICU,” Nassar said.

“Health care professionals’ burnout is associated with lower levels of care for patients. … These problems can be even worse in lower staffing units such as those in developing countries.”

Visitor policies should be implemented to ensure that nursing staff can still provide optimal care even when families have more time at the bedside, said Elizabeth Scruth, a clinical practice consultant at Kaiser Foundation Hospitals in Oakland, California, who wasn’t involved in the study.

“The take-home message here is for patients and families to advocate for liberal visiting hours and to always ask the ICU … what types of visiting hours are in place,” Scruth said by email.

“Also, place pictures and other mementos in the room of the patient to make it more home-like. … The use of ICU diaries can also aid the patient and family to leave messages, provide a daily update of what is going on and how the patient is progressing, and both families, nurses, and other medical personnel can write in them.”

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