Flexible Versus Restrictive Visiting Policies in ICUs

Antonio Paulo Nassar Junior, Bruno Adler Maccagnan Pinheiro Besen et el published a meta analysis and systematic review in critical care medicine about restrictive and flexible visiting policies in ICUs. 


Most ICUs worldwide place restrictions on visiting patients due to fear of infection, disorganization of care and increased workload on staff. Liberal visiting hours have increasingly being recognized to help with patient and family centered care. This review looked at the evidence behind it.


Pubmed, Scopus and web of science databases were searched and 1310 studies were identified. More than half were duplicates, and after excluding for quality , bias etc, only 24 full text articles were considered suitable for the meta analysis. Out of these, only 7 were included in quantitative analysis.


  1. Hospital Anxiety and Depression Scale
  2.  Likert scale for patient satisfaction
  3.  Critical Care Family Needs Inventory
  4.  Critical Care Family Satisfaction Survey
  5.  Maslach-Jackson Burnout Inventory
  6.  State-Trait Anxiety Inventory


  1. The flexible visiting policy was associated with a reduced frequency of delirium (OR, 0.39; 95% CI, 0.22–0.69; I 2 = 0%), but only two studies studied the delirium.  A Belgian cohort study involving more than 500
    patients had already demonstrated that the absence of visit was associated with a greater than three-fold increased risk of ICU patients developing delirium
  2. Eight studies found that family satisfaction was greater with flexible visiting hours.
  3. Flexible visiting hours were not associated with an increased risk of ICU mortality(4 studies), ICU-acquired infection(3 studies), or longer ICU stay(4 studies).
  4. One study showed  increase in burnout symptoms among ICU professionals, especially nurses. 


Flexible family visitation models appear to be benefcial for patients’ and family members’ outcomes. 

Chest compressions should start when systolic arterial blood pressure is below 50 mm Hg in the anaesthetised patient.Read more
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