Due to the COVID-19 pandemic, visits to patients by family members were prohibited. An Italian team has published a paper in the journal Critical Care on the benefits of allowing ICU visits during a pandemic period, proposing essential policy objectives and an operational guide to achieve them.
At the beginning of the health crisis caused by the SARS-CoV-2 virus, it was decided to prohibite family members from visiting their loved ones in hospital. These rules, which are mostly still in force, are often considered unfair by people who would like to be close to their loved ones, especially during the critical phases of an illness.
According to the paper authors, although the situation in COVID-19 wards remains extremely challenging, and while recognising the complexity involved in implementing protocols for the admission of family members, it is essential to find shared strategies adaptable to each local context to allow family members to enter COVID-19 wards.
According to the authors, the benefits of having family members present in intensive care far outweigh the pandemic risks, which can be controlled by specific protocols. Phone and video calls are not enough. The physical presence of family members makes it easier to share care strategies. It allows more effective information, greater transparency and better understanding of decision-making processes, and makes it more feasible to share care choices.
From a clinical point of view, the presence of family members offers relational benefits, especially in certain phases (e.g. at the end of the deep sedation phase). The presence of family members also strongly motivates the patient to continue the necessary treatment. Even if limited in time and conditioned by the necessary PPE, visits respond to the patient's need, increases the trust of family members and the appreciation of the care team, and diminishes the understandable difficulty of family members in accepting bad news.
The possibility of being physically close to the loved one even at the time of death, if requested by the family, helps to reduce the risk of developing psychological traumas, which may persist for a long time.
The prerequisites for visitors to enter the hospital should be:
Next are the indications given in the published paper for proceeding with the opening of intensive care units:
The pandemic abruptly interrupted a decade-long process of 'humanisation' and 'openness' of intensive care units. According to the authors, current knowledge and the availability of personal protective equipment (PPE) make it possible to encourage a careful and gradual resumption of the opening to family visits, while fully respecting the patient's wishes.
The authors consider that there is no substantial reason why family members should not be admitted to COVID-19 wards. It may not only be useful, but even necessary. In the specific context of each hospital, they believe it is necessary to do everything possible to promptly re-establish good "humanizing" practices in both intensive and non-intensive care units.
Mistraletti, G., Giannini, A., Gristina, G. et al. Why and how to open intensive care units to family visits during the pandemic. Crit Care 25, 191 (2021). https://doi.org/10.1186/s13054-021-03608-3