Physical Restraints in the Emergency Department and Attendance at Subsequent Outpatient Psychiatric Treatment

Currier, Glenn W.; Walsh, Patrick; Lawrence, David

doi:10.1097/01.pra.0000407961.42228.75

Cited by 21 publications

(26 citation statements)

References 9 publications

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“…Validated questionnaires were used to investigate the patients’ perceptions of or attitudes towards coercion or perceived trauma in an inpatient setting [46,10,50,13,45,55,57,15], others used questionnaires developed specifically for their studies [47-49,54,56,58]. See Table 2.…”

Section: Resultsmentioning

confidence: 99%

Methodological and ethical challenges in studying patients’ perceptions of coercion: a systematic mixed studies review

et al. 2014

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BackgroundDespite improvements in psychiatric inpatient care, patient restrictions in psychiatric hospitals are still in use. Studying perceptions among patients who have been secluded or physically restrained during their hospital stay is challenging. We sought to review the methodological and ethical challenges in qualitative and quantitative studies aiming to describe patients’ perceptions of coercive measures, especially seclusion and physical restraints during their hospital stay.MethodsSystematic mixed studies review was the study method. Studies reporting patients’ perceptions of coercive measures, especially seclusion and physical restraints during hospital stay were included. Methodological issues such as study design, data collection and recruitment process, participants, sampling, patient refusal or non-participation, and ethical issues such as informed consent process, and approval were synthesized systematically. Electronic searches of CINALH, MEDLINE, PsychINFO and The Cochrane Library (1976-2012) were carried out.ResultsOut of 846 initial citations, 32 studies were included, 14 qualitative and 18 quantitative studies. A variety of methodological approaches were used, although descriptive and explorative designs were used in most cases. Data were mainly collected in qualitative studies by interviews (n = 13) or in quantitative studies by self-report questionnaires (n = 12). The recruitment process was explained in 59% (n = 19) of the studies. In most cases convenience sampling was used, yet five studies used randomization. Patient’s refusal or non-participation was reported in 37% (n = 11) of studies. Of all studies, 56% (n = 18) had reported undergone an ethical review process in an official board or committee. Respondents were informed and consent was requested in 69% studies (n = 22).ConclusionsThe use of different study designs made comparison methodologically challenging. The timing of data collection (considering bias and confounding factors) and the reasons for non-participation of eligible participants are likewise methodological challenges, e.g. recommended flow charts could aid the information. Other challenges identified were the recruitment of large and representative samples. Ethical challenges included requesting participants’ informed consent and respecting ethical procedures.

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Section: Resultsmentioning

confidence: 99%

Methodological and ethical challenges in studying patients’ perceptions of coercion: a systematic mixed studies review

et al. 2014

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“…Shorter lengths of stay and a decrease in rehospitalization rates are also very important benefits [34]. Moreover, seclusion and restraint can have severe psychological and physical consequences for all individuals involved [35], a high level of patient-perceived coercion can decrease treatment satisfaction [36] and being restrained can even decrease the likelihood of attending further follow-up and treatment sessions [37]. A body of work has been developed with the aim of replacing these techniques with more adaptive strategies [38,39].…”

Section: Discussionmentioning

confidence: 99%

Health service use and costs associated with aggressiveness or agitation and containment in adult psychiatric care: a systematic review of the evidence

et al. 2015

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BackgroundAgitation and containment are frequent in psychiatric care but little is known about their costs. The aim was to evaluate the use of services and costs related to agitation and containment of adult patients admitted to a psychiatric hospital or emergency service.MethodsSystematic searches of four electronic databases covering the period January 1998-January 2014 were conducted. Manual searches were also performed. Paper selection and data extraction were performed in duplicate. Cost data were converted to euros in 2014.ResultsTen studies met inclusion criteria and were included in the analysis (retrospective cohorts, prospective cohorts and cost-of-illness studies). Evaluated in these studies were length of stay, readmission rates and medication. Eight studies assessed the impact of agitation on the length of stay and six showed that it was associated with longer stays. Four studies examined the impact of agitation on readmission and a statistically significant increase in the probability of readmission of agitated patients was observed. Two studies evaluated medication. One study showed that the mean medication dose was higher in agitated patients and the other found higher costs of treatment compared with non-agitated patients in the unadjusted analysis. One study estimated the costs of conflict and containment incurred in acute inpatient psychiatric care in the UK. The estimation for the year 2014 of total annual cost per ward for all conflict was €182,616 and €267,069 for containment based on updated costs from 2005.ConclusionsAgitation has an effect on healthcare use and costs in terms of longer length of stay, more readmissions and higher drug use. Evidence is scarce and further research is needed to estimate the burden of agitation and containment from the perspective of hospitals and the healthcare system.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0417-x) contains supplementary material, which is available to authorized users.

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“…Importantly authors have noted that previous use of restrictive interventions influences patient decisions to seek subsequent hospital care. 10 Physical restraint continues to be used despite known physical and/or psychological harm experienced by mental health patients; international concern over that restraint still occurs, as well as the call for eradication of this practice. 9 …”

Section: Introductionmentioning

confidence: 99%

Use of the Safewards Model in healthcare services: a mixed-method scoping review protocol

et al. 2020

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IntroductionSafewards is an organisational approach to delivering inpatient mental health services. The aim of Safewards is to minimise the number of situations in which conflict arises between healthcare workers and patients that lead to the use of coercive interventions (restriction and/or containment).The Safewards Model has been developed, implemented and evaluated for its impact on all forms of containment. Safewards has been adopted as the recommended approach to preventing patient agitation and clinical aggression in some jurisdictions. Notwithstanding these recommendations, the outcomes of Safewards for staff and patients have not been comprehensively described.The aim of the scoping review is to describe (1) Safewards interventions; (2) how Safewards interventions have been implemented in healthcare settings; (3) outcome measures used to evaluate the effectiveness of Safewards; (4) barriers and enablers to the uptake and sustainability of Safewards. This review will provide a foundation for further research and/or systematic review of the effectiveness of Safewards.Methods and analysisPeer-reviewed manuscripts of quantitative, qualitative and mixed-method research in English with be included for the period 01 January 2013– December 31st 2020. Electronic databases including Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase, Emcare, Joanna Briggs Institute, Medline, Global Health, PsycINFO and Scopus will be searched. Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist and explanation and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol will be followed. Publications will be excluded if they do not include the required participants, concept or context. Two reviewers will independently screen all titles and abstracts and full-text studies for inclusion.Ethics and disseminationEthical approval for this review is not required as the information to be collected is publicly available. There are no participants or safety considerations in this review of published literature. Key findings for future research and clinical practice will be disseminated though peer-reviewed publication, stakeholder reporting and conference presentations.

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Physical Restraints in the Emergency Department and Attendance at Subsequent Outpatient Psychiatric Treatment

Cited by 21 publications

References 9 publications

Methodological and ethical challenges in studying patients’ perceptions of coercion: a systematic mixed studies review

Methodological and ethical challenges in studying patients’ perceptions of coercion: a systematic mixed studies review

Health service use and costs associated with aggressiveness or agitation and containment in adult psychiatric care: a systematic review of the evidence

Use of the Safewards Model in healthcare services: a mixed-method scoping review protocol

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