Abstract Rationale Family visitation in the ICU is associated with improved patient outcomes, reduced psychological distress among family members, and less clinician burnout. However, visitor restrictions disrupt family integration into ICU care, and ICU visitation policies may play an important role in the provision of family-centered ICU care. This study aimed to characterize ICU visitation policies within VA medical centers (VAMCs) nationally. Methods A cross-sectional survey was sent to ICU nurse managers at VAMC ICUs (n = 111) between 9/2024 and 1/2025 to characterize family-centered ICU care practices. Within the survey, 57 respondents reported that their ICU utilized a written visitor policy. Among these respondents, 36 (63%) shared their ICU’s visitation policy document. Two research team members independently reviewed each policy, noting types of restrictions and exceptions, content, and relevant definitions, and alignment with recommendations for family-centered care. Conflicts were resolved by consensus. Data were analyzed using descriptive statistics and thematic analysis. Results From 34 VAMCs with a broad geographic distribution, 36 policies were reviewed. Every policy included at least one visitation restriction. The most common restrictions were of children from the ICU (n = 31, 89%) and number of visitors allowed at one time (n = 25, 69%). Over half (n = 23, 64%) detailed specific visitation hours with an average of 10 hours (range 5-13) daily. Most visitation times were during business hours (8AM-5PM), with an average of three hours available outside this timeframe. Nearly 20% (n = 7) of VAMCs had unrestricted visitor hours. Most policies (83%, n = 30) noted exceptions including visitation of children (n = 15, 42%), maximum visitors allowed (n = 17, 47%), or visiting hours (n = 18, 50%). Several family-centered care practices were not included in most policies, such as a point of contact for questions, mechanism for families to get more information on visitation policies, mention of virtual contact between families and clinicians, lodging opportunities, or access to materials in a non-English language. While some policies defined “family” (n = 21, 58%), “surrogate” (n = 10, 28%), and “visitor” (n = 4, 11%), none defined the phrase “family-centered care.” Conclusion In a national survey, visitation restrictions were common and highly variable among VAMC ICUs. Exceptions to visitation policies were poorly defined, placing the burden of interpretation and implementation of policies onto hospital staff and could result in unwarranted variation in practice. The VA’s large, national integrated health system offers opportunities to take the lead in integrating families into ICU care; however, the VA must first establish visitation policies that are family-centered and supported by evidence. This abstract is funded by: VA IIR (I01HX003789)
Erickson et al. (Fri,) studied this question.