Sometimes, it’s the simplest innovations that are the most meaningful. And sometimes those same innovations are met with disbelief. At St. Luke’s, I am thrilled that we are not just talking about patient- and family-centered care; we’re innovating and implementing – and it is making a difference! I’ve asked Holly Carlson, M.S., R.N., CCRN, director of the surgical and medical intensive care units at St. Luke’s Boise, to write about one such innovation. Her report follows:
Since the beginning of intensive care medicine, intensive care units have been extremely controlled. ICU patients are the sickest in the hospital. They require very close monitoring and detailed care from multiple members of the complex care team. Critical care nurses will say, “We watch our patient’s hair grow.” Intensive care team members are in a constant state of observation, fine-tuning treatments to maximize every patient’s recovery.
Due to the nature of the care, and long-standing misperceptions and misunderstandings related to patient support systems, visitation has historically been very controlled. Misperceptions related to over-stimulation of patients, visitors as a potential source of infection to patients, and the results of visitor exposure to treatments and the types of emergent situations that can occur in the ICU have been among the reasons for keeping ICUs locked down.
Medicine started to understand and value the importance of patients’ own support systems about 10 years ago, and we now actively promote the involvement of family members and significant others. At St. Luke’s Boise, we took a big step to support these support networks on Oct. 1, when Surgical Intensive Care adopted an “open visitation” policy.
How does research support open visitation?
Research shows that open visitation facilitates patient and support system communication with the care team. Increased communication results in increased patient satisfaction with care, and reduces patient and family anxiety by up to 75 percent. By supporting patients in their healing and recovery within their established support systems, we have found open visitation to help speed up the healing process.
Contrary to previous perception, it does not increase infection rates among patients. Our unit-based research shows that visitors are 99 percent compliant with our hand hygiene initiative.
Our research also shows a 28 percent reduction in telephone call volume as the result of implementing this policy, which means more time for care team members at the bedside, where we want to be.
Team members report that visitors are easier to communicate with. They are more prepared to hear the information the care team needs to share with them, less anxious, and calmer in their responses to situations involving their loved ones. Why? Because we have removed an anxiety-provoking barrier: the locked door that frequently resulted in acute distress while they waited for permission to enter.
Here’s what we recently heard from the family member of a stroke patient:
“I thought it was weird that the doors were open. I just walked in. I thought to myself, ‘What is going on here?’ But it was nice to just be able to visit, it was so easy.”
The last thing he and his family wanted to do was make the long drive from hundreds of miles away only to be faced with a sign pointing to a telephone so the family could ask to be with her. And because this family member is a healthcare provider, he recognized how unusual it was that the doors were open.
Visitors who are not in health care sometimes have not been able to comprehend why it has been so complicated to access ICUs. Now that we’ve made the switch, sometimes it’s hard for people to understand why this is both so innovative and so beneficial.
For St. Luke’s and our intensive care clinicians, it is important that we focus on patients and their needs. We want them to get better. This family member also noted that his family would have thought twice about interacting with the care team if the unit would have been closed, because they would have felt like they “were bugging the staff.” This is exactly what we don’t want! We want them to be involved with care, so that we provide the care our patients and their families deserve.
It is important to our Boise intensive care team members to provide an exceptional patient experience, and open visitation is an important part of that. This practice is gaining ground, and being recognized nationwide as an innovative strategy for caring for patients.
I have recently been contacted by two organizations in our region that want to know how we went about shifting our visitation approach. The data speaks for itself, but these contacts with other organizations seeking “how to” information confirm that we are doing the right thing for our patients. Our patients are our passion.
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.