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Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit: The ICU Visits Randomized Clinical Trial.

ABSTRACT: 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?

SUBMITTER: Rosa RG

PROVIDER: S-EPMC6635909 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit: The ICU Visits Randomized Clinical Trial.

Rosa Regis Goulart RG Falavigna Maicon M da Silva Daiana Barbosa DB Sganzerla Daniel D Santos Mariana Martins Siqueira MMS Kochhann Renata R de Moura Rafaela Moraes RM Eugênio Cláudia Severgnini CS Haack Tarissa da Silva Ribeiro TDSR Barbosa Mirceli Goulart MG Robinson Caroline Cabral CC Schneider Daniel D de Oliveira Débora Mariani DM Jeffman Rodrigo Wiltgen RW Cavalcanti Alexandre Biasi AB Machado Flávia Ribeiro FR Azevedo Luciano Cesar Pontes LCP Salluh Jorge Ibrain Figueira JIF Pellegrini José Augusto Santos JAS Moraes Rafael Barberena RB Foernges Rafael Botelho RB Torelly Andre Peretti AP Ayres Lizandra de Oliveira LO Duarte Pericles Almeida Delfino PAD Lovato Wilson José WJ Sampaio Patrick Harrison Santana PHS de Oliveira Júnior Lúcio Couto LC Paranhos Jorge Luiz da Rocha JLDR Dantas Alessandro da Silva ADS de Brito Pollyanna Iracema Peixoto Gouveia Gomes PIPGG Paulo Eliane Aparecida Peixoto EAP Gallindo Marcos Antônio Cavalcanti MAC Pilau Janaina J Valentim Helen Martins HM Meira Teles José Mario JM Nobre Vandack V Birriel Daniella Cunha DC Corrêa E Castro Livia L Specht Andréia Martins AM Medeiros Gregory Saraiva GS Tonietto Tulio Frederico TF Mesquita Emersom Cicilini EC da Silva Nilton Brandão NB Korte Jeffrey E JE Hammes Luciano Serpa LS Giannini Alberto A Bozza Fernando Augusto FA Teixeira Cassiano C

JAMA 20190701 3

<h4>Importance</h4>The effects of intensive care unit (ICU) visiting hours remain uncertain.<h4>Objective</h4>To determine whether a flexible family visitation policy in the ICU reduces the incidence of delirium.<h4>Design, setting and participants</h4>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- ...[more]

PMID: 31310297

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Project description:IntroductionFlexible intensive care unit (ICU) visiting hours have been proposed as a means to improve patient-centred and family-centred care. However, randomised trials evaluating the effects of flexible family visitation models (FFVMs) are scarce. This study aims to compare the effectiveness and safety of an FFVM versus a restrictive family visitation model (RFVM) on delirium prevention among ICU patients, as well as to analyse its potential effects on family members and ICU professionals.Methods and analysisA cluster-randomised crossover trial involving adult ICU patients, family members and ICU professionals will be conducted. Forty medical-surgical Brazilian ICUs with RFVMs (<4.5 hours/day) will be randomly assigned to either an RFVM (visits according to local policies) or an FFVM (visitation during 12 consecutive hours per day) group at a 1:1 ratio. After enrolment and follow-up of 25 patients, each ICU will be switched over to the other visitation model, until 25 more patients per site are enrolled and followed. The primary outcome will be the cumulative incidence of delirium among ICU patients, measured twice a day using the Confusion Assessment Method for the ICU. Secondary outcome measures will include daily hazard of delirium, ventilator-free days, any ICU-acquired infections, ICU length of stay and hospital mortality among the patients; symptoms of anxiety and depression and satisfaction among the family members; and prevalence of burnout symptoms among the ICU professionals. Tertiary outcomes will include need for antipsychotic agents and/or mechanical restraints, coma-free days, unplanned loss of invasive devices and ICU-acquired pneumonia, urinary tract infection or bloodstream infection among the patients; self-perception of involvement in patient care among the family members; and satisfaction among the ICU professionals.Ethics and disseminationThe study protocol has been approved by the research ethics committee of all participant institutions. We aim to disseminate the findings through conferences and peer-reviewed journals.Trial registrationNCT02932358.

Project description:BackgroundAn intensive care unit (ICU) admission is a stressful event for the patient and the patient's family. Several studies demonstrated symptoms of anxiety, depression, and posttraumatic stress disorder in family members of patients admitted to ICU. Some studies recognize that the open visitation policy (OVP) is related to a reduction in symptoms of anxiety and depression for the patient and an improvement in family satisfaction. However, some issues have been presented as barriers for the adoption of that strategy. This study was designed to evaluate perceptions of physicians, nurses, and respiratory therapists (RTs) of an OVP and to quantify visiting times in a Brazilian private intensive care unit (ICU).MethodsThis observational and descriptive study was performed in the medical-surgical (22 beds) and neurologic ICU (8 beds) of Sírio-Libanês Hospital (HSL), São Paulo, Brazil. All physicians, nurses, and RTs from ICU were invited to participate in the study. A questionnaire was applied to all ICU workers who accepted to participate in the study. The questionnaire consisted of 22 questions about the visiting policy. During five consecutive days, we evaluated the time that the visitors stayed in the patient room, as well as the type of visitor.ResultsA total of 106 ICU workers participated in this study (42 physicians, 39 nurses, and 25 RTs). Only three of the questions exposed a negative perception of the visiting policy: 53.3% of the participants do not think that the OVP consistently increases family satisfaction with patient's care; 59.4% of ICU workers think that the OVP impairs the organization of the patient's care; 72.7% of participants believe that their work suffers more interruptions because of the OVP. The median visiting time per day was 11.5 hours.ConclusionsAccording to physicians, nurses, and respiratory therapists, the greatest impact of OVP is the benefit to the patients rather than to the family or to the staff. Furthermore, they feel that they need communication training to better interact with family members who are present in the ICU 24 hours per day.

Project description:BACKGROUND/OBJECTIVE:Delirium in the intensive care units (ICUs) is prevalent, with both delirium duration and delirium severity associated with adverse outcomes. We designed a pragmatic trial to test the efficacy of a pharmacological management of delirium (PMD) bundle in improving delirium/coma-free days and reducing delirium severity among ICU patients. DESIGN:A randomized pragmatic clinical trial. SETTING:Medical, surgical, and progressive ICUs of three tertiary care hospitals. PARTICIPANTS:A total of 351 critically ill patients. INTERVENTION:A multicomponent PMD bundle consisting of reducing the exposure to 20 definite anticholinergic medications and benzodiazepines and prescribing low-dose haloperidol. MEASUREMENTS:The primary outcomes were delirium/coma-free days, measured through the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the ICU (CAM-ICU), and delirium severity, measured through Delirium Rating Scale-Revised-98 and the CAM-ICU-7. Secondary outcomes were in-hospital and posthospital discharge 30-day mortality, ICU and hospital lengths of stay, and delirium-related hospital complications. RESULTS:We randomized 351 critically ill delirious patients (mean age = 59.3 years [SD = 16.9 years]; 52% female, 42% African Americans) to receive the PMD bundle or usual care. There were no significant differences in median delirium/coma-free days at day 8 (PMD vs usual care = 4 [interquartile range {IQR} = 2-7] days vs 5 [IQR = 1-7] days; P = .888) or at day 30 (PMD vs usual care = 26 [IQR 19-29] days vs 26 [IQR, 14-29] days; P = .991). There were no significant differences for decrease in delirium severity at day 8, but at hospital discharge, the intervention group showed a greater reduction in delirium severity (mean decrease in CAM-ICU-7 score for PMD vs usual care = 3.2 [SD = 3.3] vs 2.5 [SD = 3.2]; P = .046). No differences were observed between groups for ICU and hospital lengths of stay, mortality, and delirium-related hospital complications. Similar results were observed when analyses were limited to patients 65 years or older and 75 years or older. CONCLUSION AND RELEVANCE:Implementing the PMD bundle in the ICU did not reduce delirium duration or severity among critically ill patients. TRIAL REGISTRATION:clinicaltrials.gov Identifier: NCT00842608. J Am Geriatr Soc 67:1057-1065, 2019.

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Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit: The ICU Visits Randomized Clinical Trial.

Publications

Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit: The ICU Visits Randomized Clinical Trial.

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