A mixed-methods evaluation of a quality improvement initiative for flexible ICU visits in an Australian quaternary centre

Abstract

Background: Restrictive ICU visitation is a recognised source of caregiver distress, particularly at the end-of-life. In response to recurring caregiver feedback, we implemented a criteria-based flexible visitation model in a large Australian ICU. We evaluated the implementation, its impact on caregiver experience and its acceptability among ICU staff. Methods: We conducted a mixed-methods evaluation of a two-phase quality improvement initiative that comprised the Blue Dot pathway (flexible visitation for patients at the end-of-life) and the Orange Dot pathway (criteria-based flexible visitation for selected patients with compassionate needs). De-identified caregiver feedback from a bereavement follow-up service was retrospectively analysed. Comments about visitation were coded as positive or negative, and compared before and after each phase. Staff acceptability was assessed via an anonymous survey. Results: For the Blue Dot pathway, 271 surveys were analysed (129 before, 142 after). Negative comments decreased from 14.4% to 3.3% (−11.1%; 95% CI −17.3 to −4.7; p = 0.006), and positive comments increased modestly but were not significant. For the Orange Dot pathway, 180 surveys were analysed (95 before, 85 after); there was no significant change in positive sentiment (+5.3%; p = 0.18) or negative sentiment (+2.6%; p = 0.33). A total of 136 staff responded (25% response rate), and 72% supported continuation. Conclusion: Flexible ICU visitation was associated with reduced negative caregiver feedback during end-of-life care and high staff acceptability. It was extended to broader patient groups and demonstrated high levels of staff acceptability, although no significant change in caregiver sentiment was observed. Keywor ds: flexible visitation · Intensive Care Unit · end-of-life · compassionate care · caregiver experience