Open ICUs Are Good for Patients

I already spoke in support of open ICUs.Here's some stuff more or less in the way of evidence.

Way back in 2004 a commentary was published in JAMA proposing open ICU visitation. It addressed three main objections staff raise: that family members stress the patient, that family gets in the way of the staff, and that families can't handle the stressful and gruesome sights of the ICU. I think families getting in the way and being grossed out can be handled judiciously by the wise nurse. A nurse who can't use confidence and discretion to skillfully manage visitors is not a good nurse for the bedside experience.
But as for patient stress, I thought this was interesting:

The concern that the patient should be left alone to rest incorrectly assumes that family presence at the bedside causes stress. The empirical literature suggests that the presence of family and friends tends to reassure and soothe the patient, providing sensory organization in an overstimulated environment and familiarity in unfamiliar surroundings. Visits of family and friends do not usually increase patients' stress levels, as measured by blood pressure, heart rate, and intracranial pressure, but may in fact lower them. Nursing visits, on the other hand, often increase stress. (emphasis mine)

In January of last year, Paul Levy analyzed this from an administration point of view, and describes eliminating ICU visiting hour restrictions. He received many professional comments, not all of them pleased. These he addressed further in a guest post here.

There's also plenty of 'open ICUs are coming! it's the end of the world!!' discussion on allnurses. The nurses there bring up one point not addressed in that JAMA article: HIPAA violations. Letting visitors in for more than 15 minutes every four hours is somehow going to violate privacy regulations left and right. And yet, somehow they accomplish this on the regular medical floors, and in psych units where HIPAA probably applies more than anywhere. One ICU I worked at utilized passwords—you know, the patient or next of kin makes a password, and no info is given over the phone or in person without it. And for large families, they had no qualms asking for one person (preferably the DPOA or closest kin) to be the point of contact between the family and the physicians and nurses. So it's not the end of the world.

The revulsion some nurses have for open ICUs kind of gets to the crux of the matter: these rules are there for us, not them. I understand that you don't want families in the way, but this patient is not yours. They belong to themselves and their families much more than they belong to you. It drives us nuts when a physician is there for five minutes making decisions without your input for a patient you have for twelve hours. How do you think an informed, prudent family member or visitor feels when you, who they've never met, treat them like an intruder?

Last month Levy described the nuts and bolts of opening ICU to visitors, and how they made innovative changes to reform the ICU experience for patients and families, such as (something I've thought of!) pagers for families so we can reach them. How often does the physician arrive for his momentary daily visit just after the family, after a 16 hour bedside vigil, went to find a much-needed cup of coffee?

All in all, I think the open ICU, with reasonable restrictions and useful innovations, is just how it's gonna be. So it irritates me now when hospitals fail to implement it.