Opening the ICU doors

Family member presence may contribute to the healing of hospitalized patients, but may also be in conflict with the perceived needs of delivering intensive care. We detail our experience with "opening the doors" of the intensive care unit (ICU), allowing family members to be present and participate in the care of loved ones without restriction. "Opening the doors" challenged the traditions, legacy and sense of professional entitlement that were a part of ICU culture and generated considerable initial resistance among nurses and physicians. We describe our "opening the doors" transformation to more patient- and family-centered care in four steps: (1) enlist support of administrative and local leaders; (2) create a collective aim; (3) test on a small scale, and (4) scale up after initial successes. Preparing ICU staff so that they are comfortable with more "on stage" time (i.e., greater family presence) was critical to our success. "Opening the doors" now serves as a guiding vision to organizing the ICU's work.