title: Consent, involuntary treatment, and the use of force in an urban emergency department.
abstract: OBJECTIVE
  To determine the frequency of, and patient population requiring involuntary treatment orders in the emergency department.
  
  
  METHODS
  Retrospective review of all patients requiring involuntary treatment orders during a one-month study period.
  
  
  METHODS
  An urban, university hospital, adult emergency department with 45,000 annual patient visits.
  
  
  RESULTS
  Three hundred fourteen of 3,637 patients (8.5%) required involuntary treatment orders. Orders used were observation and detention (57%), seclusion only (9%), restraint only (26%), or seclusion plus restraint (7%). Forty-six percent of patients arrived through the emergency medical services system; the remainder were brought by police or family or were self-referred. More patients required these interventions on the second shift. Most detained and secluded patients had psychiatric diagnoses and dispositions, whereas 100% of restrained patients had medical or surgical diagnoses, and nearly 50% required medical or surgical admissions.
  
  
  CONCLUSIONS
  The frequent need for involuntary treatment orders for patients in an urban ED is reported. The patient population described, especially among restrained patients, differs significantly from those of studies performed in psychiatric settings. Legal doctrines pertinent to involuntary treatment are reviewed.
authors.affiliation: Department of Emergency Medicine, University of Louisville School of Medicine, KY.
authors.forename: F W
authors.initials: FW
authors.lastname: Lavoie
mesh_terms: D000328:Adult; D000368:Aged; D032763:Behavior Control; D003068:Coercion; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010356:Patient Isolation / Q000706:statistics & numerical data; D012149:Restraint, Physical / Q000331:legislation & jurisprudence / Q000379:methods / Q000523:psychology; D012189:Retrospective Studies; D012637:Security Measures / Q000706:statistics & numerical data*; D016312:Treatment Refusal / Q000523:psychology