Restraints utilization in a psychiatric emergency room

Abstract

ABSTRACTThe utilization of restraints is an important quality measure of psychiatric services including the emergency and inpatient services. The practice, however, continues to generate controversy and differing opinions in terms of its ethics and clinical utility. Prompt identification of patient and environmental factors that are most frequently associated with the need for restraints may provide useful tools to help clinicians as they triage patients in psychiatric emergency settings. Proactive measures such as behavioral interventions can reduce the need for restraints and improve the quality of care provided to patients. We conducted a systematic retrospective review of all restraint orders between January 2016 and June 2016 in the psychiatry emergency of a community hospital in an urban setting. Data was analyzed using descriptive statistics and Chi-square to determine associations between patient demographic characteristics, primary diagnoses and the use of restraints. Results show that 2.9 percent of patients in the present study required restraints. Manual hold was by far the most utilized (88.4%); 53.7 percent of all the patients had a positive urine toxicology for illicit substances, mostly Marijuana (31.6%). We also reported a significant association between the patient’s primary diagnosis and the frequency of restraints (p = 0.004), the most frequent diagnosis being the schizophrenia spectrum (69.5%).In conclusion, our study presents characteristics and descriptors of patients who required restraints. An early identification of patients’ diagnosis and any co-morbid substance abuse and a prompt and proactive management of patients may reduce the need for restraints in psychiatric emergency room settings.