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. χ2 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. χ2 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
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