The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Comparison of Emergency Physicians'and Juris Doctors' Opinions on Emergency Department Patient Restraints Usage

Authors: Darryl Macias, MD, Steven Weiss, MD, Amy Ernst, MD, W. Ann Maggiore, JD, Todd Nick, PhD, David Sklar, MD

Abstract

Objectives: Emergency physicians (EPs) and Juris Doctors (JDs) often disagree on the correct use of restraints for emergency department (ED) patients. The objective of the study was to compare EPs and JDs propensity to restrain patients given various scenarios. The study hypothesis was that EPs and JDs would agree on when to restrain emergency patients.


Methods: This was a prospective cross-sectional study. Twenty-two EPs and 27 JDs were asked to complete the Video Assessment of Propensity to use Emergency Restraints Scale (VAPERS). The VAPERS scale consists of 17 scenarios utilizing actors who were videotaped to produce a scale. Results obtained include overall likelihood to restrain and likelihood to restrain specific subgroups of patients such as those who are a danger to themselves, a danger to others, medically unstable, trauma patients, altered patients, belligerent patients, agitated patients, calm patients, and patients with normal mental status. A two-way mixed model average intraclass correlation coefficient (ICC) was used to determine scale reliability. Unpaired t-tests with confidence intervals (CI) were used to compare the two professions on VAPERS results and on individual scenarios.


Results: Overall, EPs were more likely to restrain patients than JDs (46% vs 37%), although this did not reach statistical significance. The statistically significant EP-JD disagreement, with EPs more likely to restrain patients, occurred if the patients were calm. Common themes in the differences emerged from evaluation of the two groups' comments.


Conclusions: EPs and JDs disagree on restraint use. These EP-JD differences were statistically significant in patients who were calm.


Key Points


* Emergency physicians and attorneys differ in their understanding of medication interactions, the ability of a busy emergency department to watch difficult patients, the family's role in preventing an adult from leaving the emergency department, the effect of systemic disease on mental status, communication between the patient and staff, and the consequences of traumatic injuries.


* By clarifying these differences, we hope to develop means to improve the understanding between the two professions.


* By developing focused education of both professions, we can decrease the differences between them and improve overall patient care.

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