Longer visiting hours in ICU associated with less patient delirium

The effect was greatest in older patients, surgical patients, those with more severe illness, and patients who did not have psychiatric disorders or require parenteral sedation or mechanical ventilation, according to the single-center study.

Extended visiting hours were associated with reductions in delirium and ICU length of stay, according to a trial in one medical-surgical ICU.

The prospective before-and-after study was conducted in a 31-bed medical-surgical ICU in Brazil. It included all patients 18 years of age or older admitted to the ICU between May 2015 and November 2015 with an expected length of stay of at least 24 hours. For the 141 patients in the before group, visiting hours were restricted to 4.5 hours per day. For the 145 patients in the after group, visiting hours were extended to 12 hours per day. Results were published by Critical Care Medicine on June 30.

Median duration of visits increased from 133 minutes under the restrictive policy to 245 minutes after the hours were expanded (P<0.001). The percentage of patients who developed delirium (measured twice daily with the Confusion Assessment Method) also decreased, from 20.5% (29 patients) to 9.6% (14 patients). There were also decreases in the median length of delirium or coma (3.0 days vs. 1.5 days; P=0.03) and ICU stay (4.0 days vs. 3.0 days; P=0.04).

To examine potential adverse outcomes of extended visiting hours, researchers also compared rates of ICU-acquired infections and found no significant difference between the groups.

Subgroup analyses found that the delirium reduction effect was greatest in patients 65 years or older (relative risk [RR], 0.43; 95% CI, 0.22 to 0.87), surgical patients (RR, 0.51; 95% CI, 0.27 to 0.97), patients without psychiatric disorders (RR, 0.34; 95% CI, 0.13 to 0.89), patients who did not require parenteral sedation (RR, 0.32; 95% CI, 0.11 to 0.88), patients with APACHE-II scores of 15 points or more (RR, 0.32; 95% CI, 0.14 to 0.72), and patients who did not require mechanical ventilation (RR, 0.31; 95% CI, 0.11 to 0.85). The authors noted that these effects might be explained by the subgroups being more susceptible to delirium (such as the elderly and those with high APACHE-II scores) or less likely to be sedated.

A reduction in delirium from extended visiting hours is scientifically plausible, the study authors said. Longer or more frequent visits could allow better communication between patients and ICU staff, reduce patient stress and anxiety, or reinforce treatment adherence. The study was limited by the risk of bias inherent in its prospective design, the failure to evaluate the impact of the change on ICU staff, and the uncertain generalizability of a single-center study. However, the study shows that extending ICU visiting hours is an achievable component of patient- and family-centered care that can help “keep patient humanity at such a difficult moment,” the authors said.