A Modified Delphi Process to Prioritize Experiences and Guidance Related to ICU Restricted Visitation Policies During the Coronavirus Disease 2019 Pandemic

Kirsten M. Fiest, PhD; Karla D. Krewulak, PhD; Kira Makuk, BHSc; Natalia Jaworska, MD, MSc; Laura Hernández, BA; Sean M. Bagshaw, MD, MSc; Karen E. Burns, MD, MSc; Deborah J. Cook, MD, MSc; Christopher J. Doig, MD, MSc; Alison Fox-Robichaud, MD, MSc; Robert A. Fowler, MD, MSc; Michelle E. Kho, PT, PhD; Ken Kuljit S. Parhar, MD, MSc; Oleksa G. Rewa, MD, MSc; Bram Rochwerg, MD, MSc; Bonnie G. Sept; Andrea Soo, PhD; Sean Spence, MD; Andrew West, EdD; Henry T. Stelfox, MD, PhD; Jeanna Parsons Leigh, PhD; for the Canadian Critical Care Trials Group; Kusum Menon; Vazquez Grande; Mark Duffet; Jennifer Foster; Dominique Piquette; Nicole Zytaruk; Sylvie Debigaré; Srinivas Murthy; Danaë Tassy; Sangeeta Mehta

doi:10.1097/CCE.0000000000000562

Critical Care Explorations (Oct 2021)

A Modified Delphi Process to Prioritize Experiences and Guidance Related to ICU Restricted Visitation Policies During the Coronavirus Disease 2019 Pandemic

Kirsten M. Fiest, PhD,
Karla D. Krewulak, PhD,
Kira Makuk, BHSc,
Natalia Jaworska, MD, MSc,
Laura Hernández, BA,
Sean M. Bagshaw, MD, MSc,
Karen E. Burns, MD, MSc,
Deborah J. Cook, MD, MSc,
Christopher J. Doig, MD, MSc,
Alison Fox-Robichaud, MD, MSc,
Robert A. Fowler, MD, MSc,
Michelle E. Kho, PT, PhD,
Ken Kuljit S. Parhar, MD, MSc,
Oleksa G. Rewa, MD, MSc,
Bram Rochwerg, MD, MSc,
Bonnie G. Sept,
Andrea Soo, PhD,
Sean Spence, MD,
Andrew West, EdD,
Henry T. Stelfox, MD, PhD,
Jeanna Parsons Leigh, PhD,
for the Canadian Critical Care Trials Group,
Kusum Menon,
Vazquez Grande,
Mark Duffet,
Jennifer Foster,
Dominique Piquette,
Nicole Zytaruk,
Sylvie Debigaré,
Srinivas Murthy,
Danaë Tassy,
Sangeeta Mehta

Affiliations

Kirsten M. Fiest, PhD: 1 Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
Karla D. Krewulak, PhD: 1 Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
Kira Makuk, BHSc: 1 Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
Natalia Jaworska, MD, MSc: 1 Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
Laura Hernández, BA: 1 Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
Sean M. Bagshaw, MD, MSc: 4 Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada.
Karen E. Burns, MD, MSc: 6 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Deborah J. Cook, MD, MSc: 9 Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Christopher J. Doig, MD, MSc: 1 Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
Alison Fox-Robichaud, MD, MSc: 10 Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Robert A. Fowler, MD, MSc: 6 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Michelle E. Kho, PT, PhD: 13 School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
Ken Kuljit S. Parhar, MD, MSc: 1 Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
Oleksa G. Rewa, MD, MSc: 4 Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada.
Bram Rochwerg, MD, MSc: 10 Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Bonnie G. Sept: 1 Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
Andrea Soo, PhD: 1 Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
Sean Spence, MD: 1 Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
Andrew West, EdD: 15 Canadian Society of Respiratory Therapists, Saint John, NB, Canada.
Henry T. Stelfox, MD, PhD: 1 Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
Jeanna Parsons Leigh, PhD: 16 Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.
for the Canadian Critical Care Trials Group
Kusum Menon
Vazquez Grande
Mark Duffet
Jennifer Foster
Dominique Piquette
Nicole Zytaruk
Sylvie Debigaré
Srinivas Murthy
Danaë Tassy
Sangeeta Mehta

DOI: https://doi.org/10.1097/CCE.0000000000000562
Journal volume & issue: Vol. 3, no. 10
p. e0562

Abstract

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OBJECTIVES:. To create evidence-based consensus statements for restricted ICU visitation policies to support critically ill patients, families, and healthcare professionals during current and future pandemics. DESIGN:. Three rounds of a remote modified Delphi consensus process. SETTING:. Online survey and virtual polling from February 2, 2021, to April 8, 2021. SUBJECTS:. Stakeholders (patients, families, clinicians, researchers, allied health professionals, decision-makers) admitted to or working in Canadian ICUs during the coronavirus disease 2019 pandemic. MEASUREMENTS AND MAIN RESULTS:. During Round 1, key stakeholders used a 9-point Likert scale to rate experiences (1—not significant, 9—significant impact on patients, families, healthcare professionals, or patient- and family-centered care) and strategies (1—not essential, 9—essential recommendation for inclusion in the development of restricted visitation policies) and used a free-text box to capture experiences/strategies we may have missed. Consensus was achieved if the median score was 7–9 or 1–3. During Round 2, participants used a 9-point Likert scale to re-rate experiences/strategies that did not meet consensus during Round 1 (median score of 4–6) and rate new items identified in Round 1. During Rounds 2 and 3, participants ranked items that reached consensus by order of importance (relative to other related items and experiences) using a weighted ranking system (0–100 points). Participants prioritized 11 experiences (e.g., variability of family’s comfort with technology, healthcare professional moral distress) and developed 21 consensus statements (e.g., communicate policy changes to the hospital staff before the public, permit visitors at end-of-life regardless of coronavirus disease 2019 status, creating a clear definition for end-of-life) regarding restricted visitation policies. CONCLUSIONS:. We have formulated evidence-informed consensus statements regarding restricted visitation policies informed by diverse stakeholders, which could enhance patient- and family-centered care during a pandemic.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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