Comparison of mechanical restraint use in a metropolitan ED after system change: A before and after analysis

Abstract

Background

Prior to 2020, Nepean ED had high rates of restraint of mental health (MH) patients compared to peer hospitals. Restraint can cause emotional and physical trauma to patients and staff and should be used as seldom as possible. The ED undertook a project to reduce the number and duration of restraint episodes, involving telepsychiatry, culture change, staff education, increasing use of sedation and bedside engagement in de-escalation techniques.

Objectives

To compare the differences in mechanical restraint episodes between 2019 and 2021 calendar years, after a year of change implementation in 2020.

Method

A single-centre retrospective cohort analysis of patients requiring mechanical restraint for MH complaints in 2019 and 2021 was conducted. Presentations of all MH patients were identified from the electronic medical record. Episodes of restraint were identified from the ED restraint register, and a file review of the electronic medical record was conducted to obtain data.

Results

In 2021, there was a 11.5% increase in total MH presentations (2705 vs 3056). There was a decrease in the proportion of MH patients experiencing restraint from 8.8% to 6.3% (difference 2.5%; 95% CI 1.1%–3.8%). Mean duration of restraint decreased from 385 to 229 min (difference 145; 95% CI 93.3–196.2) and use of sedation in restrained patients increased from 58.6% to 72.9% (difference 16%; 95% CI 6.8%–25.1%).

Conclusion

After a year of change implementation, there was a reduction in the use of restraints and an increase in the use of sedation in 2021 when compared to 2019.