Verbal de-escalation to reduce the use of mechanical restraint during nonvoluntary ambulance transfers.

Abstract

Objectives: To evaluate the usefulness of annual training in verbal de-escalation techniques for reducing the use of mechanical restraints during nonvoluntary ambulance transfers of patients with mental health problems who need emergency care.

Material and methods: Quasi-experimental before-after study. Patients with mental diseases treated by a psychiatric team and transferred from home without their consent were included from January through December 2008 in Barcelona. Since 2013, the team had been attending annual training sessions in verbal de-escalation based on the recommendations of the BETA project (Best Practices in the Evaluation and Treatment of Agitation). We compared the prevalence of the use of mechanical restraint before and after the team started verbal de-escalation training. We also analyzed variables associated with the need to use restraints.

Results: Patients in 633 nonvoluntary transfers were included. Mechanical restraints were used in 42.0% of transfers before de-escalation training and in 20.6% of transfers afterwards, reflecting a 50.1% reduction. Logistic regression identified younger age and the presence of psychotic symptoms as factors associated with the use of restraints; the use of verbal de-escalation was a protective factor (P 0.005).

Conclusion: Annual training in verbal de-escalation techniques following the BETA project's recommendations led to a 50% reduction in the need to use mechanical restraint during nonvoluntary ambulance transfers of patients with mental health problems.