Flexible ICU visitation improves caregiver experience: a two-phase intervention study in an Australian Quaternary Centre

Background: Restrictive bedside visitation rules in our 48‑bed adult ICU generated persistent negative feedback from caregivers during end-of-life care (EOLC) follow‑up calls. Flexible visiting has been shown to improve patient and caregiver-centred outcomes in critical care, but staff perceptions of obstacles to work and an increased workload make implementation difficult. Methods: A two-phased intervention was implemented following feedback from our EOLC follow‑up service: the Blue Dot pathway permitting unrestricted visiting for dying patients and the Orange Dot pathway extending flexible visiting to any patient with a compelling compassionate need. Using a mixed-methods framework, anonymised data was sourced through our institution's end-of-life follow-up service. Caregiver visitation comments were retrospectively coded as positive (P) or negative (N). Proportions of positive and negative comments before and after each intervention were compared with two‑proportion z‑tests. Staff acceptance was assessed through an anonymous survey, and a subsequent thematic analysis informed future practice. Results: Blue Dot visitation reduced negative feedback comments from 14.4–3.3% (Δ − 11.1%, 95% CI − 17.3 to − 4.7, p = 0.006) and increased positive comments by 4.5% (p = 0.25). Orange Dot visitation increased positive comments by 5.3% (p = 0.18) with low negative sentiment (Δ + 2.6%, p = 0.33). Among 136 staff respondents (25% of all ICU staff), 72% supported permanent criteria-based flexible visitation. Conclusion: Criteria-based flexible visitation in our institution reduced negative caregiver feedback at the end of life. Extending criteria maintained low negativity and improved positivity, and was widely accepted by the staff surveyed.