Icu visitor restriction policies and approaches to family engagement during the COVID-19 pandemic

INTRODUCTION: Communication with family members of ICU patients has changed dramatically during the COVID-19 pandemic. To investigate these changes, we interviewed site project leaders among ICUs that had participated in the Family Engagement Collaborative (FEC), a shared learning experience begun by SCCM in September 2019 that promoted ICU family engagement projects among participating sites before being cancelled in March 2020 due to COVID-19. METHODS: We developed a structured set of survey questions regarding the impact of COVID-19 on ICU family visitation and engagement and assessed content validity via an iterative process amongst FEC leadership. From June 9 to July 17, we contacted the site leader of all 27 ICUs that had participated in the FEC and administered the survey by phone. We also asked site leaders to provide a copy of their current visitor restriction policy. RESULTS: 22/27 (81.5%) site leaders participated. When asked about the peak of the pandemic in their respective ICUs, 2 sites (9.1%) reported having had a strict no-visitor policy without any exceptions. The remaining sites all reported a variety of exceptions, with a majority allowing visitation for patients at the end-of-life. Regarding current policies, all sites now have some visitor restriction exceptions in place, but with significant variability;at least half (12, 54.5%) of sites now permit at least 1 visitor for non-COVID patients during defined visitor hours. Four sites (21.1%) reported that their hospital did not provide PPE to visitors. 16 sites (84.2%) were unclear of their hospital's timeline for further relaxing visitor restrictions. All but 1 site (95.5%) reported now using video conferencing with families;however, 10 sites (47.6%) reported clinicians' using their own personal devices for conferencing. Among hospitals providing devices for staff, approximately 1 device had been provided on average for every 13 ICU beds. CONCLUSIONS: While ICU visitor policies have somewhat relaxed since the peak of the pandemic, there is considerable uncertainty about how policies might change moving forward. ICUs need additional resources to provide PPE for visitors and to ensure adequate video conferencing capabilities on hospital devices.

Lessons learned from the sccm family engagement collaborative prior to the COVID-19 pandemic

INTRODUCTION: The Family Engagement Collaborative (FEC) was a year-long shared learning experience begun by SCCM in September 2019 that utilized educational webinars, conference calls, listserv communications, and centralized family and clinician data collection to promote ICU family engagement projects among participating sites. We describe lessons learned from the FEC up to the point at which it was cancelled due to COVID-19, at a time when most sites had just begun local project implementation. METHODS: During an orientation period, sites reported on their selected local projects via scheduled conference calls and an online listserv. All sites also planned individual methods of assessing project impact via pre- and postimplementation data collection, with the option of utilizing an SCCM REDCap database for FS-ICU 24R and IPFCC Clinician Survey data starting in January 2020. After the FEC was cancelled in March 2020, each site leader was contacted to participate in a structured phone exit interview. RESULTS: Among 27 actively participating ICUs, the most common projects were creating ICU orientation videos, packets, or educational programs (12, 44.4%) promoting structured family care conferences (6, 22.2%), and implementing ICU diaries (5, 18.5%). 212 FS-ICU 24R surveys and 346 IPFCC Clinician Surveys collected across sites before project implementation highlighted a broad need for improving family support. After cancellation, 22 site leaders (81.5%) completed an interview. 20 sites (90.1%) reported stopping their project implementation due to the pandemic. The only 2 sites that continued projects were implementing (1) a standardized palliative extubation protocol and (2) daily written summaries for families of non-decisional patients. When all site leaders were asked to rate how helpful the FEC had been from a scale of 0-10, mean response was 8.0 (SD 2.5). Seven leaders (25.9%) suggested that a future FEC could benefit by focusing more on sites implementing a specific standardized project, as opposed to promoting a variety of different ideas. CONCLUSIONS: While the pandemic had a profound impact on sites' implementation of family-centered care projects that are of clear need, participants found value in the FEC's educational and communication model and provided actionable feedback for future iterations.