• Kirsten M Fiest, Karla D Krewulak, Laura C Hernández, Natalia Jaworska, Kira Makuk, Emma Schalm, Sean M Bagshaw, Xavier Bernet, BurnsKaren E AKEAInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada.Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada, Philippe Couillard, Christopher J Doig, Robert Fowler, Michelle E Kho, Shelly Kupsch, François Lauzier, Daniel J Niven, Taryn Oggy, Oleksa G Rewa, Bram Rochwerg, Sean Spence, Andrew West, Henry T Stelfox, Jeanna Parsons Leigh, and Canadian Critical Care Trials Group.
• Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada. kmfiest@ucalgary.ca.
• Can J Anaesth. 2022 Jul 1; 69 (7): 868879868-879.

PurposeHospital policies forbidding or limiting families from visiting relatives on the intensive care unit (ICU) has affected patients, families, healthcare professionals, and patient- and family-centered care (PFCC). We sought to refine evidence-informed consensus statements to guide the creation of ICU visitation policies during the current COVID-19 pandemic and future pandemics and to identify barriers and facilitators to their implementation and sustained uptake in Canadian ICUs.MethodsWe created consensus statements from 36 evidence-informed experiences (i.e., impacts on patients, families, healthcare professionals, and PFCC) and 63 evidence-informed strategies (i.e., ways to improve restricted visitation) identified during a modified Delphi process (described elsewhere). Over two half-day virtual meetings on 7 and 8 April 2021, 45 stakeholders (patients, families, researchers, clinicians, decision-makers) discussed and refined these consensus statements. Through qualitative descriptive content analysis, we evaluated the following points for 99 consensus statements: 1) their importance for improving restricted visitation policies; 2) suggested modifications to make them more applicable; and 3) facilitators and barriers to implementing these statements when creating ICU visitation policies.ResultsThrough discussion, participants identified three areas for improvement: 1) clarity, 2) accessibility, and 3) feasibility. Stakeholders identified several implementation facilitators (clear, flexible, succinct, and prioritized statements available in multiple modes), barriers (perceived lack of flexibility, lack of partnership between government and hospital, change fatigue), and ways to measure and monitor their use (e.g., family satisfaction, qualitative interviews).ConclusionsExisting guidance on policies that disallowed or restricted visitation in intensive care units were confusing, hard to operationalize, and often lacked supporting evidence. Prioritized, succinct, and clear consensus statements allowing for local adaptability are necessary to guide the creation of ICU visitation policies and to optimize PFCC.© 2022. The Author(s).

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