Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 26 , ISSUE 3 ( March, 2022 ) > List of Articles

Original Article

Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East

Prashant Nasa, Maher J Al Bahrani, Ashraf Al Tayar, Madiha Hashmi, Vinod Jaiswal, Sandeep Kantor, Bassam Mansour, Anushka D Mudalige, Rashid Nadeem, Gentle S Shrestha, Ahmed R Taha, Melda Türkoğlu, Dameera Weeratunga

Keywords : Communication barrier, Do not resuscitate orders, End-of-life care, Family communication, Informed consent, Informed consent document, Patient visitors, Terminal care, Visitors to patients

Citation Information : Nasa P, Al Bahrani MJ, Al Tayar A, Hashmi M, Jaiswal V, Kantor S, Mansour B, Mudalige AD, Nadeem R, Shrestha GS, Taha AR, Türkoğlu M, Weeratunga D. Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East. Indian J Crit Care Med 2022; 26 (3):268-275.

DOI: 10.5005/jp-journals-10071-24091

License: CC BY-NC 4.0

Published Online: 30-03-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Purpose: The coronavirus disease-2019 (COVID-19) pandemic had affected the visiting or communicating policies for family members. We surveyed the intensive care units (ICUs) in South Asia and the Middle East to assess the impact of the COVID-19 pandemic on visiting and communication policies.

Materials and method: A web-based cross-sectional survey was used to collect data between March 22, 2021, and April 7, 2021, from healthcare professionals (HCP) working in COVID and non-COVID ICUs (one response per ICU). The topics of the questionnaire included current and pre-pandemic policies on visiting, communication, informed consent, and end-of-life care in ICUs.

Results: A total of 292 ICUs (73% of COVID ICUs) from 18 countries were included in the final analysis. Most (92%) of ICUs restricted their visiting hours, and nearly one-third (32.3%) followed a “no-visitor” policy. There was a significant change in the daily visiting duration in COVID ICUs compared to the pre-pandemic times (p = 0.011). There was also a significant change (p <0.001) in the process of informed consent and end-of-life discussions during the ongoing pandemic compared to pre-pandemic times.

Conclusion: Visiting and communication policies of the ICUs had significantly changed during the COVID-19 pandemic. Future studies are needed to understand the sociopsychological and medicolegal implications of revised policies.

Supplementary Files:
Appendix 1 Survey
Supplement 2 CROSS


HTML PDF Share
  1. Kynoch K, Chang A, Coyer F, McArdle A. The effectiveness of interventions to meet family needs of critically ill patients in an adult intensive care unit: a systematic review update. JBI Database System Rev Implement Rep 2016;14(3):181–234. DOI: 10.11124/JBISRIR-2016-2477.
  2. Alfheim HB, Hofsø K, Småstuen MC, Tøien K, Rosseland LA, Rustøen T. Post-traumatic stress symptoms in family caregivers of intensive care unit patients: a longitudinal study. Intensive Crit Care Nurs 2020;50:5–10. DOI: 10.1016/j.iccn.2018.05.007.
  3. CoBaTrICE Collaboration. The views of patients and relatives of what makes a good intensivist: a European survey. Intensive Care Med 2007;33:1913–1920. DOI: 10.1007/s00134-007-0799-4.
  4. Azoulay E, Sprung CL. Family-physician interactions in the intensive care unit. Crit Care Med 2004;32(11):2323–2328. DOI: 10.1097/01.ccm.0000145950.57614.04.
  5. Lee MD, Friedenberg AS, Mukpo DH, Conray K, Palmisciano A, Levy MM. Visiting hours policies in New England intensive care units: strategies for improvement. Crit Care Med 2007;35(2):497–501. DOI: 10.1097/01.CCM.0000254338.87182.AC.
  6. Heras La Calle G, Oviés ÁA, Tello VG. A plan for improving the humanisation of intensive care units. Intensive Care Med 2017;43(4):547–549. DOI: 10.1007/s00134-017-4705-4.
  7. Pollard K, Wessman BT. Development of a standardized communication intervention bundle for use at a medical training hospital intensive care unit. Indian J Crit Care Med 2019;23(5):234–235. DOI: 10.5005/jp-journals-10071-23168.
  8. Rosa RG, Falavigna M, Robinson CC, da Silva DB, Kochhann R, de Moura RM, et al. Study protocol to assess the effectiveness and safety of a flexible family visitation model for delirium prevention in adult intensive care units: a cluster-randomised, crossover trial (The ICU Visits Study). BMJ Open 2018;8(4):e021193. DOI: 10.1136/bmjopen-2017-021193.
  9. Nassar Junior AP, Besen BAMP, Robinson CC, Falavigna M, Teixeira C, Rosa RG. Flexible versus restrictive visiting policies in ICUs: a systematic review and meta-analysis. Crit Care Med 2018;46(7): 1175–1180. DOI: 10.1097/CCM.0000000000003155.
  10. Auerbach A, O'Leary KJ, Greysen SR, Harrison JD, Kripalani S, Ruhnke GW, et al. Hospital ward adaptation during the COVID-19 pandemic: a national survey of academic medical centers. J Hosp Med 2020;15(8):483–488. DOI: 10.12788/jhm.3476.
  11. Valley TS, Schutz A, Nagle MT, Miles LJ, Lipman K, Ketcham SW, et al. Changes to visitation policies and communication practices in Michigan ICUs during the COVID-19 pandemic. Am J Respir Crit Care Med 2020;202(6):883–885. DOI: 10.1164/rccm.202005-1706LE.
  12. Griffin KM, Karas MG, Ivascu NS, Lief L. Hospital preparedness for COVID-19: a practical guide from a critical care perspective. Am J Respir Crit Care Med 2020;201(11):1337–1344. DOI: 10.1164/rccm.202004-1037CP.
  13. CDC. Management of visitors to healthcare facilities in the context of COVID-19: non-US healthcare settings. 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/non-us-settings/hcf-visitors.html/ [Accessed July 29, 2021].
  14. WHO. Infection prevention and control of epidemic-and pandemic prone acute respiratory infections in health care. 2020. Available from: https://www.who.int/publications/i/item/infection-prevention-and-control-of-epidemic-and-pandemic-prone-acute-respiratory-infections-in-health-care/ [Accessed July 29, 2021].
  15. Pillalamarri A. South Asia: tethered to the Middle East; Southeast Asia: tethered to China. The Diplomat. 2020. Available from: https://thediplomat.com/2016/03/south-asia-tethered-to-the-middle-east-southeast-asia-tethered-to-china/ [Accessed July 24, 2021].
  16. Jahn Kassim PN, Alias F. Religious, ethical and legal considerations in end-of-life issues: fundamental requisites for medical decision making. J Relig Health 2016;55(1):119–134. DOI: 10.1007/s10943-014-9995-z.
  17. Rose L, Yu L, Casey J, Cook A, Metaxa V, Pattison N, et al. Communication and virtual visiting for families of patients in intensive care during COVID-19: a UK National Survey. Ann Am Thorac Soc 2021;18(10):1685–1692. DOI: 10.1513/AnnalsATS.202012-1500OC.
  18. Boulton AJ, Jordan H, Adams CE, Polgarova P, Morris AC, Arora N. Intensive care unit visiting and family communication during the COVID-19 pandemic: a UK survey. J Intensive Care Soc 2021. DOI: 10.1177/17511437211007779.
  19. Chowdhury D, Duggal AK. Intensive care unit models: do you want them to be open or closed? A critical review. Neurol India 2017;65(1):39–45. DOI: 10.4103/0028-3886.198205.
  20. Sharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, et al. A consensus-based checklist for reporting of survey studies (CROSS). J Gen Intern Med 2021;36(10):3179–3187. DOI: 10.1007/s11606-021-06737-1.
  21. Olding M, McMillan SE, Reeves S, Schmitt MH, Puntillo K, Kitto S. Patient and family involvement in adult critical and intensive care settings: a scoping review. Health Expect 2016;19(6):1183–1202. DOI: 10.1111/hex.12402.
  22. Ning J, Cope V. Open visiting in adult intensive care units–a structured literature review. Intensive Crit Care Nurs 2020;56:102763. DOI: 10.1016/j.iccn.2019.102763.
  23. Khaleghparast S, Joolaee S, Ghanbari B, Maleki M, Peyrovi H, Bahrani N. A review of visiting policies in intensive care units. Glob J Health Sci 2015;8(6):267–276. DOI: 10.5539/gjhs.v8n6p267.
  24. Modra LJ, Hart GK, Hilton A, Moore S. Informed consent in the intensive care unit: the experiences and expectations of patients and their families. Crit Care Resusc 2014;16(4):262–268. PMID: 25437219.
  25. Immad SQ. DNAR decisions in Pakistan, Middle East, and UK: an emergency physician's perspective. South Asian J Emerg Med 2018;2(1):1–5. DOI: 10.5455/sajem.020107.
  26. Madadin M, Alsaffar GM, AlEssa SM, Khan A, Badghaish DA, Algarni SM, et al. Clinicians’ attitudes towards do-not-resuscitate directives in a teaching hospital in Saudi Arabia. Cureus 2019;11:e6510. DOI: 10.7759/cureus.6510.
  27. Baykara N, Utku T, Alparslan V, Arslantaş MK, Ersoy N. Factors affecting the attitudes and opinions of ICU physicians regarding end-of-life decisions for their patients and themselves: a survey study from Turkey. PLoS One 2020;15(5):e0232743. DOI: 10.1371/journal.pone.0232743.
  28. Mathur R. ICMR consensus guidelines on ‘do not attempt resuscitation’. Indian J Med Res 2020;151(4):303–310. DOI: 10.4103/ijmr.IJMR_395_20.
  29. Choudhuri AH, Sharma A, Uppal R. Effects of delayed initiation of end-of-life care in terminally ill intensive care unit patients. Indian J Crit Care Med 2020;24(6):404–408. DOI: 10.5005/jp-journals-10071-23454.
  30. Ersek M, Smith D, Griffin H, Kinder D, Thorpe JM, Kutney-Lee A. End-of-life care in the time of COVID-19: communication matters more than ever. J Pain Symptom Manage 2021;S0885-3924(20)30975-1. DOI: 10.1016/j.jpainsymman.2020.12.024.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.