Open visiting policy for adult patients in intensive care units: A systematic review and meta-analysis

Objective: To critically evaluate the comparative effects of open or flexible family visitation policies versus restricted or traditional visitation policies on the incidence of delirium and other major outcomes among adult patients admitted to intensive care units (ICUs). Data Sources: It was conducted a comprehensive electronic search of MEDLINE, EMBASE, Scopus, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to November 21, 2025. Study Selection: It was included randomized controlled trials (RCTs) comparing open or flexible versus restricted ICU visiting policies in adult patients. Data Extraction: The primary outcome extracted was delirium incidence. Secondary outcomes included the duration of invasive mechanical ventilation (IMV), ICU length of stay, hospital-acquired infections and ICU mortality. Data Synthesis: Fourteen RCTs comprising 3,920 patients were included. Random-effects models showed that compared with restricted policies, open/flexible visitation reduced delirium incidence (OR 0.51, 95% CI 0.33–0.80; low certainty) and IMV duration (MD −0.36 days, 95% CI −0.46 to -0.26; low certainty). The intervention did not affect the ICU length of stay (mean difference 4.21, 95% CI -4.65-13.07; very low certainty), the rates of hospital-acquired infections (OR 1.00, 95% CI 0.81-1.23; low certainty) or ICU mortality (OR 0.87, 95% CI 0.71-1.07; very low certainty). Conclusions: Open/flexible ICU visitation may reduce delirium and shorten the duration of IMV slightly, without increasing infections or mortality, although the certainty of evidence is low and heterogeneity remains substantial.