published Tuesday, September 2nd, 2014

Open visitation in area hospital ICUs comforts patients, relatives

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    Nurse Shannon Mirabella, left, checks on Tom Benjamin Sanford, Jr., as his daughter, Connie Simms watches Thursday in Erlanger's ICU.
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As a nurse in the intensive care unit, Meghan Buffat always thought she empathized with her patients’ families.

Three times a day, she would watch them — the husbands and wives, the children and cousins — file into the unit to visit their sick and injured loved ones, trying to bring whatever bit of comfort they could to those hooked up to the tubes and machines.

Just 30 minutes later, they all would head back out again when the ICU’s doors closed.

It wasn’t until Buffat’s own baby, three months premature, fought for his life for 10 weeks in the neonatal intensive care unit that she really grasped what those families were going through.

But unlike the adult ICU she worked in, Buffat had more than 30 minutes with her son each day. She could freely visit him, day and night.

“Open visitation was my saving grace,” she said. “It just relieved so much anxiety, and it helped me to be involved in his care.”

So at the beginning of this year, when Erlanger decided to experiment with opening up visitation in its adult ICUs, Buffat — assistant nurse manager for the medical ICU — was on board.

She understood that changing from 90 minutes to 16 hours of visitation a day was a perplexing shift for some doctors and nurses, but she felt it was worth it.

“Having that experience with my son just made me realize how important it is for families to see their loved ones more than half an hour a day.”

Erlanger’s decision to open up the ICU is a revolutionary move, reflecting a changing attitude among hospitals toward visitation, experts say.

Chris Clarke, who oversees the Tennessee Hospital Association’s Center for Patient Safety, said easier visitation is part of a changing dynamic in how hospitals treat patients’ support groups, Clarke explained.

“There is a renewed focus on patient-focused care that means better engaging with patients’ families,” Clarke said. “Hospitals are no longer just assuming they know what patients’ families need, but are actually asking them.”

But even some hospitals that have embraced more visitor-friendly policies remain wary of opening up the ICU, saying that it creates obstacles for treating the most critical cases.

Memorial Health Care System and Parkridge Health System still have more limited hours, but officials add that both have brought more flexibility to their visitation in recent years.

A survey of more than 600 hospitals in 2008 and 2009 by the journal Critical Care showed more than three-quarters limit visiting hours, and nearly 90 percent of ICUs have restrictive policies.

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    Connie Simms visits with her father, Tom Benjamin Sanford Jr., Thursday in Erlanger's ICU.
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CULTURE CHANGE

True to its name, an ICU is an intense climate.

The beeps, hums and alarms echoing through the ward are a constant reminder of lives on the line — seriously sick and injured people who need help breathing and whose every heartbeat is tracked.

The quarters are crowded with machines and tubes. Doctors, nurses and therapists duck in and out of rooms in a steady stream.

Outsiders may bring infection, interfere with care or keep patients from getting adequate rest, hospital officials fear.

And in an already tense environment, wouldn’t adding stressed family members only make things more volatile?

But a growing number of studies claim there is little evidence that open visitation causes harm, and say it can even improve the patient’s long-term outcome. Families have long been welcome in the ICUs for children, for example.

“Evidence shows that the unrestricted presence and participation of a support person can enhance patient and family satisfaction, because it improves the safety of care,” a 2011 report from the American Association of Critical Care Nurses says.

“This is especially true in the ICU, where the patients are usually intubated and cannot speak for themselves.”

In turn, medical staff can help caregivers better understand how to care for their loved one in the long term.

When Erlanger quality officials decided they wanted to try the new model, there was some hesitation even among ICU leadership.

“It was a big culture change,” said Ted Nelson, nurse manager for Erlanger’s medical and surgical ICUs. “So I did have some concerns and reservations. But if the data supported it, we were willing to try it.”

After the first day with the new hours, staff members said they were surprised by how well it went. Weeks and months later, they had grown comfortable with the arrangement, Nelson reported.

Family members were especially happy about the change, he said.

“They could leave work at lunch time and visit, instead of waiting for those blocks of time that were very limited,” he said.

With all the potential advantages of having an open ICU, the doctors and nurses still have to keep control of the room.

A situation can deteriorate quickly, Nelson explained. Staff may have ask families to leave or decide not allow them to enter in order to properly care for one of their patients.

“In ICU, you have to balance that desire to be open with tight quarters, complex care, really sick people,” said Clarke.

Jerri Underwood, chief nursing executive for Parkridge, said the hospital maintains a more restrictive stance on adult ICU visitation — 40 minutes, three times a day — out of patients’ best interest.

“Our primary focus is to protect the patients,” she said, citing concerns over privacy, infection and adverse social dynamics.

Still, Parkridge’s ICUs will work to create special visiting schedules for families who work odd hours, she said.

“If we work with the family, it improves that patient’s outcome,” Underwood said. “When [family] comes in and they give the patient a hug, talk to them in a familiar voice — that really grounds them.”

Memorial, too, has a more traditional visitation model, but extended its hours last year to one-hour blocks four times a day, hospital spokesman Joshua Ball said.

He added that the hospital has “increased flexibility as much as possible, keeping in mind the needs of each patient and our desire to provide a safe environment for optimal healing.”

Memorial also tries to tailor visitation to the needs of the patient and family.

Clarke said more hospitals are trying to adopt this kind of case-by-case approach.

“Although we’re medical professionals, we recognize the need for an active partnership with the patient’s support group,” she said. “The direction we’re heading in is toward more inclusiveness.”

Contact staff writer Kate Harrison Belz at kbelz@timesfreepress.com or 423-757-6673.

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