Scott A Simpson1, Jutta M Joesch2, Imara I West2, Jagoda Pasic2. 1. Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98195, USA. Electronic address: simpsons@uw.edu. 2. Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98195, USA.
Abstract
OBJECTIVE: We describe risk factors associated with patients experiencing physical restraint or seclusion in the psychiatric emergency service (PES). METHODS: We retrospectively reviewed medical records, nursing logs and quality assurance data for all adult patient encounters in a PES over a 12-month period (June 1, 2011-May 31, 2012). Descriptors included demographic characteristics, diagnoses, laboratory values, and clinician ratings of symptom severity. χ(2) and multivariate logistic regression analyses were performed. RESULTS: Restraint/seclusion occurred in 14% of 5335 patient encounters. The following characteristics were associated with restraint/seclusion: arrival to the PES in restraints; referral not initiated by the patient; arrival between 1900 and 0059 hours; bipolar mania or mixed episode; and clinician rating of severe disruptiveness, psychosis or insight impairment. Severe suicidality and a depression diagnosis were associated with less risk of restraint or seclusion. CONCLUSION: Acute symptomatology and characteristics of the encounter were more likely to be associated with restraint/seclusion than patient demographics or diagnoses. These findings support recent guidelines for the treatment of agitation and can help clinicians identify patients at risk of behavioral decompensation.
OBJECTIVE: We describe risk factors associated with patients experiencing physical restraint or seclusion in the psychiatric emergency service (PES). METHODS: We retrospectively reviewed medical records, nursing logs and quality assurance data for all adult patient encounters in a PES over a 12-month period (June 1, 2011-May 31, 2012). Descriptors included demographic characteristics, diagnoses, laboratory values, and clinician ratings of symptom severity. χ(2) and multivariate logistic regression analyses were performed. RESULTS: Restraint/seclusion occurred in 14% of 5335 patient encounters. The following characteristics were associated with restraint/seclusion: arrival to the PES in restraints; referral not initiated by the patient; arrival between 1900 and 0059 hours; bipolar mania or mixed episode; and clinician rating of severe disruptiveness, psychosis or insight impairment. Severe suicidality and a depression diagnosis were associated with less risk of restraint or seclusion. CONCLUSION: Acute symptomatology and characteristics of the encounter were more likely to be associated with restraint/seclusion than patient demographics or diagnoses. These findings support recent guidelines for the treatment of agitation and can help clinicians identify patients at risk of behavioral decompensation.
Authors: Y Nina Gao; Matthew Oberhardt; David Vawdrey; Ryan E Lawrence; Lisa B Dixon; Sean X Luo Journal: J Clin Psychiatry Date: 2021-12-14 Impact factor: 4.384
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