Abstract
The purpose of this study was to investigate restraint use in Australian emergency departments (EDs). A retrospective audit of restraint incidents in four EDs (from 1 January 2010 to 31 December 2011). The restraint rate was 0.04% of total ED presentations. Males and females were involved in similar numbers of incidents. Over 90% of restrained patients had a mental illness diagnosis and were compulsorily hospitalised. Mechanical restraint with the use of soft shackles was the main method used. Restraint was enacted to prevent harm to self and/or others. Median incident duration was 2 hours 5 minutes. In order to better integrate the needs of mental health clients, consideration is needed as to what improvements to procedures and the ED environment can be made. EDs should particularly focus on reducing restraint duration and the use of hard shackles.
Highlights
Despite significant debate regarding its use in psychiatric care, including renewed media scrutiny, restraint is still used in Australian health care settings to manage risk of harm and as a method for managing disturbed behaviour.[1,2] There are deleterious physical and psychological outcomes associated with restraint use, with the potential for asphyxiation and suffocation, aspiration, thrombosis, and other harmful physiological reactions.[3,4] Patients often describe restraint as a form of punishment, and report it to be traumatic and to involve significant distress.[4]One emerging issue is the use of restraint with patients presenting to the emergency department (ED) with psychiatric problems
This study examines the use of restraint in EDs in South Australia
There were 144 restraint incidents in the four EDs, with 115 patients restrained at least once. This represents 0.97 incidents per 100 mental health presentations and 0.77 patients restrained per 100 mental health presentations (Table 1)
Summary
Despite significant debate regarding its use in psychiatric care, including renewed media scrutiny, restraint is still used in Australian health care settings to manage risk of harm and as a method for managing disturbed behaviour.[1,2] There are deleterious physical and psychological outcomes associated with restraint use, with the potential for asphyxiation and suffocation, aspiration, thrombosis, and other harmful physiological reactions.[3,4] Patients often describe restraint as a form of punishment, and report it to be traumatic and to involve significant distress.[4]. ED environments may increase agitation for already distressed patients, and are often not be equipped for patients at risk of harm.[6,7,8]
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