Flexible Family Visitation Policy Does Not Cut Delirium in ICU

Compared with standard restricted visiting hours, a flexible family visitation policy does not significantly reduce the incidence of delirium among patients in the intensive care unit (ICU), according to a study published in the July 16 issue of the Journal of the American Medical Association.

Regis Goulart Rosa, M.D., Ph.D., from the Hospital Moinhos de Vento in Porto Alegre, Brazil, and colleagues conducted a cluster-crossover randomized clinical trial in 36 adult ICUs with restricted visiting hours. Participants were recruited and randomly assigned to either flexible visitation (up to 12 hours per day) supported by family education (837 patients, 652 family members, and 435 clinicians) or usual restricted visitation (median, 1.5 hours; 848 patients, 643 family members, and 391 clinicians).

The researchers found that with flexible visitation, the mean daily duration of visits was significantly higher (4.8 versus 1.4 hours). There was no significant difference in the incidence of delirium during ICU stay for flexible versus restricted visitation (18.9 versus 20.1 percent; adjusted difference, −1.7 percent; 95 percent confidence interval, −6.1 to 2.7 percent; P = 0.44). Six of nine prespecified secondary outcomes did not differ significantly between the groups. Median anxiety and depression scores were significantly better for family members with flexible visitation.

"Although flexible visitation resulted in increased presence of family members at the bedside and in higher perception of involvement in multiple strategies aimed to prevent delirium, such as reorientation, mobilization, and pain control, it was insufficient to prevent delirium," the authors write.

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