I was sick and you came to visit me: time spent at the bedsides of seriously ill patients with poor prognoses

Purpose To learn how much time hospital staff and families spend at the bedsides of seriously ill patients with poor prognoses. Subjects and methods An observational study was made of 58 inpatients with cancer, acquired immunodeficiency syndrome, heart failure, obstructive lung disease, or advanced dementia, along with their families and the physicians and nurses working on the medical floors of a university hospital, using direct videotape surveillance of patients’ doorways. Results The mean (±SD) total visitor-minutes spent in the rooms of these patients was 321 ± 297 minutes per day. On average, patients spent 18 hours 39 minutes per day alone. Mean visit durations were 3 ± 3 minutes for attending physicians (including consultants), 3 ± 2 minutes for house officers, 2 ± 1 minutes for nurses, and 24 ± 51 minutes for family. The total person-visits per patient per day were 3 ± 3 for attending physicians, 9 ± 8 for house officers, 45 ± 23 for nurses, and 13 ± 21 for family. Patient sex and age were not significantly associated with total visitor-minutes. In a repeated-measures analysis of variance model, nonwhite patients received fewer total visitor-minutes than did white patients, and patients with dementia received fewer total visitor-minutes than did patients with other diagnoses, especially those with malignancy. Do-not-resuscitate orders were associated with slightly more total visitor-minutes. Conclusions These seriously ill patients with poor prognoses spent most of their time in the hospital alone. Staff visits were frequent but brief. These data do not confirm anecdotal reports that staff members spend less time at the bedsides of patients with do-not-resuscitate orders. Patients with advanced dementia and minority patients appear to have less bedside contact. Further study is required to confirm these findings and to understand optimal visit time for medical inpatients with poor prognoses.