Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey
Authors: Langer Thomas , Depalo Francesca Carmela , Forlini Clarissa , Landini Silvia , Mezzetti Andrea , Previtali Paola , Monti Gianpaola , de Toma Carolina , Biscardi Davide , Giannini Alberto , Fumagalli Roberto , Mistraletti Giovanni ,   on behalf of the COMVISCOV group, Lissoni Barbara , De Martini Andrea , Mareto Nadia , Rossitto Concetta , Zummo Ugo , Taverna Martina , Machieraldo Patrizia , Navarra Mauro , Parlanti Garbero Massimiliano , Scaletti Chiara , Perno Silvia , Amendolia Luca , Montrucchio Giorgia , Veliaj Deliana , Barbarello Giuseppe , Alesci Maria , Bolgiaghi Luca , Vailati Davide , Pezzi Angelo , Boselli Enrico , Piccoli Francesca , Greco Massimiliano , Gemma Marco , Resta Marco , Crotti Stefania , Bottino Nicola , Abruzzese Chiara , Savioli Monica , Migliorino Giuseppina , Muttini Stefano , Umbrello Michele , Borghi Beatrice , Greco Stefano , Dizeo Micaela , Bottiroli Maurizio , Mondino Michele Giovanni , Prosepri Manlio , Casella Giampaolo , Curto Francesco , Zaniboni Matteo , Giudici Riccardo , Gentile Carlo , Bombino Michela , Rona Roberto , Cortinovis Barbara , Benini Annalisa , Avalli Leonello , Tavola Mario , Ferrario Matteo , Preda Roberta , Primerano Enzo , Russo Gianluca , Porta Virginia , Valdambrini Federico , Fassini Paola , Orando Serena , Beck Eduardo , Pedeferri Matteo , Cogliati Giacomina , Testini Denise , Moroni Benedetta , Codeluppi Vito , Ruggeri Patrizia , Milanesi Elisa , Belliato Mirko , Besozzi Alessandra , Riccio Mario , Zerbi Silvia , Corbella Davide , Ferri Francesco , Grazioli Lorenzo , Bonanomi Ezio , Giacomini Matteo , Sacchi Noemi , Codognola Cristian , Ambrosini Alessandra , Guatteri Luca , Subert Matteo , Castelli Gian Paolo , Borelli Massimo , Venier Erica , Dittura Loredana , Buttera Stefania , Bigai Roberto , Magnoni Sandra , Rauch Simon , Colombo Angelo , Fullin Giorgio , Donolato Caterina , Cattin Silvia , State Veronica , Redeghieri Enrico , Russo Alessandro , Pastorini Simonetta , Allena Sandra , Munari Marina , Turchet Federica , Peta Mario , De Santis Vincenzo , Scala Cristina , Facondini Francesca , Marangoni Elisabetta , Tassinati Tania , Zanzani Chiara , Russo Emanuele , Marchio Annamaria , Barbagallo Maria , Girardis Massimo , Taffache Paolo , Mordacci Marco , Vincenzi Matteo , Pennica Michele , Bracciotti Giovanna , Iori Paola , Gambi Davide , Cappellini Iacopo , Vegnuti Lara , De Luca Alessandra , Romagnoli Stefano , Mosti Giamila , Carla Rossella , Roticiani Valeria , Pelagalli Lorella , Fuselli Ennio , D’Avino Emilio , De Bellis Massimo , Gianni Giulia , Leonardis Francesca , Rossi Marzia , Lorusso Rossana , Magnanimi Eugenia , Martelli Sabrina , Baisi Floriana , Balsamo Davide , Cotticelli Virginia , Mattei Alessia , Farinelli Ivano , Riccini Teresa , Cola Luisanna , Jorio Antonella , Iacobone Emanuele , Domizi Roberta , Pizzi Simone , Nasso Armando , Graziani Romano , Monaco Anna , Manno Manuela , Ottelio Carla Maria , Del Rio Michela , Serra Antonio , Enna Barbara , Loddo Francesco Marco , Galbiati Rita , Mellea Serena , Kimberly Michelle Brozzi , Vissani Matteo , Romito Francesco Massimo , Baccari Laura , Zarrillo Nadia , Esposito Clelia , Murino Patrizia , Notaro Salvatore , Ausiello Carmine , Marra Annachiara , Policastro Carmela , Cafora Chiara , De Benedectis Giuseppe , Di Falco Vincenzo , Sciddurlo Maria , Negro Giancarlo , Vetuschi Paolo , Recchia Andrea , Pasquariello Rita , Squillace Rosalba , Ciambrone Antonio , Bencivenga Carmela , Camiolo Melania , Agozzino Cristina , Oliveri Francesco , Notarrigo Tiziana , Castiglione Giacomo , Mo Antonella , Condorelli Laura , Favarato Martina 
Published: June 2022

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.