Original Article

Resource Utilization with the Use of Seclusion and Restraint in a Dedicated Emergency Psychiatric Service

Authors: Christina Terrell, MD, Kanwar Brar, MD, Sharon Nuss, MS, Rif S. El-Mallakh, MD


Objectives: There is a dearth of data regarding the use of emergency interventions in dedicated emergency psychiatric service settings, and reliable data are needed. This article describes the frequency and duration of the use of seclusion and restraint for imminent or existing agitation, aggression, or violence in a dedicated emergency psychiatric service located within an academic university hospital and staffed by sufficient numbers of trained personnel.

Methods: We performed a retrospective chart review of 6 months’ visits to a dedicated emergency psychiatric service.

Results: Men outnumbered women with a 1.6 ratio of visits. Of 2843 subjects, 425 (14.6%) received emergent medication for anxiety (n = 90), substance withdrawal (n = 28), or agitation (n = 290). Physical interventions were used in 3.4%; 96 (3.3%) were secluded, and 9 (0.3%) were restrained. The average duration of seclusion was (mean ± standard deviation) 58.7 ± 37.4 minutes and for restraint 63.2 ± 23.4 minutes. Each episode of seclusion or restraint required approximately 3 hours of staff time.

Conclusions: The use of an intervention such as seclusion in >3% and restraint in 0.3% of patients represents the use of seclusion and restraint in a dedicated psychiatric emergency service with personnel trained to minimize the use of seclusion and restraint.

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1. Knox DK, Holloman GH, Jr. Use and avoidance of seclusion and restraint: consensus statement of the American Association for Emergency Psychiatry Project Beta Seclusion and Restraint Workgroup. West J Emerg Med 2012;13:35-40.
2. Lebel J, Goldstein R. The economic cost of using restraint and the value added by restraint reduction or elimination. Psychiatr Serv 2005;56:1109-1114.
3. Huckshorn KA. Reducing seclusion and restraint use in inpatient settings: a phenomenological study of state psychiatric hospital leader and staff experiences. J Psychosoc Nurs Ment Health Serv 2014;52:40-47.
4. Blair EW, Woolley S, Szarek BL, et al. Reduction of seclusion and restraint in an inpatient psychiatric setting: a pilot study. Psychiatr Q 2017;88:1-7.
5. Strauss G, Glenn M, Reddi P, et al. Psychiatric disposition of patients brought in by crisis intervention team police officers. Community Ment Health J 2005;41:223-228.
6. McCurdy JM, Haliburton JR, Yadav HC, et al. Case study: design may influence use of seclusion and restraint. HERD 2015;8:116-121.
7. Hvidhjelm J, Sestoft D, Skovgaard LT, et al. Sensitivity and specificity of the Brø Violence Checklist as predictor of violence in forensic psychiatry. Nord J Psychiatry 2014;68:536-542.
8. San L, Marksteiner J, Zwanzger P, et al. State of acute agitation at psychiatric emergencies in Europe: the STAGE Study. Clin Pract Epidemiol Ment Health 2016;12:75-86.
9. Simpson SA, Joesch JM, West II, et al. Risk for physical restraint or seclusion in the psychiatric emergency service (PES). Gen Hosp Psychiatry 2014;36:113-118.
10. Wale JB, Belkin GS, Moon R. Reducing the use of seclusion and restraint in psychiatric emergency and adult inpatient services-improving patient-centered care. Perm J 2011;15:57-62.
11. D’Orio BM, Purselle D, Stevens D, et al. Reduction of episodes of seclusion and restraint in a psychiatric emergency service. Psychiatr Serv 2004;55:581-583.
12. Cannon ME, Sprivulis P, McCarthy J. Restraint practices in Australasian emergency departments. Aust N Z J Psychiatry 2001;35:464-467.
13. Gerace A, Pamungkas DR, Oster C, et al. The use of restraint in four general hospital emergency departments in Australia. Australas Psychiatry 2014;22:366-369.
14. Chan J, LeBel J, Webber L. The dollars and sense of restraints and seclusion. J Law Med 2012;20:73-81.
15. Frueh BC, Knapp RG, Cusack KJ, et al. Patients’ reports of traumatic or harmful experiences within the psychiatric setting. Psychiatr Serv 2005;56:1123-1133.
16. Ling S, Cleverley K, Perivolaris A. Understanding mental health service user experiences of restraint through debriefing: a qualitative analysis. Can J Psychiatry 2015;60:386-392.
17. Mohr WK, Petti TA, Mohr BD. Adverse effects associated with physical restraint. Can J Psychiatry 2003;48:330-337.
18. El-Badri S, Mellsop G. Patient and staff perspectives on the use of seclusion. Australas Psychiatry 2008;16:248-252.
19. Muir-Cochrane EC, Baird J, McCann TV. Nurses’ experiences of restraint and seclusion use in short-stay acute old age psychiatry inpatient units: a qualitative study. J Psychiatr Ment Health Nurs 2015;22:109-115.
20. Guivarch J, Cano N. Use of restraint in psychiatry: feelings of caregivers and ethical perspectives. Encephale 2013;39:237-243.
21. Yang CP, Hargreaves WA, Bostrom A. Association of empathy of nursing staff with reduction of seclusion and restraint in psychiatric inpatient care. Psychiatr Serv 2014;65:251-254.
22. Stewart D, Van der Merwe M, Bowers L, et al. A review of interventions to reduce mechanical restraint and seclusion among adult psychiatric inpatients. Issues Ment Health Nurs 2010;31:413-424.