Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey
Thomas Länger, Francesca Carmela Depalo, Clarissa Forlini, Silvia Landini, Andrea Mezzetti, Paola Previtali, Gianpaola Monti, Carolina De Toma, Davide Biscardi, Alberto Giannini, Roberto Fumagalli, Giovanni Mistraletti, on behalf of the COMVISCOV group, Barbara Lissoni, Andrea Martini, Nadia Mareto, Concetta Rossitto, Ugo Zummo, Martina Taverna, Patrizia Machieraldo, Mauro Navarra, Massimiliano Parlanti Garbero, Chiara Scaletti, Silvia Perno, Luca Amendolia, Giorgia Montrucchio, Deliana Veliaj, Giuseppe Barbarello, Maria Alesci, Luca Bolgiaghi, Davide Vailati, Angelo Pezzi, Enrico Boselli, Francesca Piccoli, Massimiliano Greco, Marco Gemma, Marco Resta, Stefania Crotti, Nicola Bottino, Chiara Abruzzese, M. Savioli, Giuseppina Migliorino, Stefano Muttini, Michele Umbrello, Beatrice Borghi, Stefano Greco, Micaela Dizeo, Maurizio Bottiroli, Michele Mondino, Manlio Prosepri, Giampaolo Casella, Francesco Lo Curto, Matteo Zaniboni, Riccardo Giudici, Carlo Gentile, Michela Bombino, Roberto J. Rona, Barbara Cortinovis, Annalisa Benini, Leonello Avalli, Mario Tavola, Matteo Ferrario, Roberta Preda, Enzo Primerano, Gianluca Russo, Virginia Porta, Federico Valdambrini, Paola Fassini, Serena Orando, Eduardo Beck, Matteo Pedeferri, Giacomina Cogliati, Denise Testini, Benedetta Moroni, Vito Codeluppi, Patrizia Ruggeri, Elisa Milanesi, Mirko Belliato, Alessandra Besozzi, Mario Riccio, Silvia Zerbi, Davide Corbella, Francesco Ferri, Lorenzo Grazioli, Ezio Bonanomi, Matteo Giacomini, Noemi Sacchi, Cristian Codognola, Alessandra Ambrosini, Luca Guatteri, Matteo Subert, Gian Paolo Castelli, Massimo Borelli, Erica Venier, Loredana Dittura, Stefania Buttera, Roberto Bigai, Sandra Magnoni, Simon Rauch, Angelo Colombo
Abstract
BACKGROUND: During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. METHODS: A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. RESULTS: Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0-6]%, 0 [0-4]% and 11 [2-25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic. CONCLUSIONS: Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted.