Datapoints: use of restraint before and after implementation of the new HCFA rules.

Abstract

138 T use of physical restraint in psychiatric settings is highly controversial, and the issue is all the more contentious for the lack of systematic data collection and careful evaluation of indications, methods, outcomes, and adverse events. In July 1999 the Health Care Financing Administration (HCFA), now the Centers for Medicare and Medicaid Services, issued rules on restraint and seclusion for general and psychiatric hospitals that participate in Medicare and Medicaid (1). The rules require that a physician or a licensed independent practitioner make a face-to-face assessment of a patient within one hour of the initiation of restraint or seclusion. The “one-hour rule” has provoked tremendous debate as smaller and rural facilities struggle to comply with this “unfunded mandate.” The rules also shorten the interval between mandatory renewal orders, codify requirements for staff training, and create more stringent requirements for documentation. No data on the use of restraints on inpatient psychiatric wards have been published since these rules were put into effect. We report information about restraint episodes on four psychiatric units with a total of 80 beds at the University of Rochester Medical Center during the three months before Use of Restraint Before and After Implementation of the New HCFA Rules