Background: Although reduction and potentially elimination of use of restraints in the management of psychiatric patients is ideal, it is important to also consider ways to improve the safety, effectiveness, and psychological sequelae of physical restraints given their continued necessity in certain situations. We compared data from use of the 4-point bed restraint (June 2018-June 2019) to use of the chair restraint (August 2019-August 2020) to determine what changes, if any, the new form of restraint brought about in the psychiatric unit. Curiously, we found that the number of events increased dramatically, from 10 during the year of 4-point restraints to 53 during the year when the chair was used instead. However, the average time spent in restraints decreased from 71.7 minutes in the bed to 47.1 minutes in the chair. The purpose of this Quality Improvement project was to explore these trends.

Methods: We surveyed staff who had been involved with behavioral emergencies, evaluating their experiences with restraint types as well as their perceptions of ease of use, efficacy, utility, patient safety, and staff safety.

Results: Staff perceive that the use of the chair on our adolescent ward is useful, safe, and preferable to use of bed restraints. Experience with the chair restraint is correlated with a more favorable view. Staff expressed mixed (but overall positive) feelings over the potential for chair use in adult populations.

Conclusions: Results suggest that variables such as safety, humaneness, ease of communication, and usefulness may be at play. Success using the chair on the adolescent unit with favorable perceptions by those who have experience with it suggest that a trial of the restraint chair in the adult population would be seen as useful and might increase staff perception of its utility. Mitigation strategies may help decrease number of restraint events in the future.