Three were situated within teaching hospitals classified as principal referral hospitals (bed numbers ranged from 308 to 874), and one was located within a hospital classified as a medium (group 1) hospital (80 beds).12 Although one ED was located in a significantly smaller hospital, total ED presentations were approximately 11,000 more than the second largest hospital in the study. All EDs used mechanical restraint (restricting the patient’s movement with devices such as shackles or belts) and physical/hands-on restraint by a staff member; only one ED had a seclusion room and used this form of restraint.