title: Organizational and unit factors contributing to reduction in the use of seclusion and restraint procedures on an acute psychiatric inpatient unit.
abstract: OBJECTIVE
  The use of seclusion or restraint (S/R) as an emergency medical intervention to assist patients in regaining behavioral control continues to be an area of interest and concern for the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), consistent with the ongoing concerns in the medical, patient advocate, legislative and legal communities. This study examined unit characteristics and the use of S/R in a VA facility with a secured, acute mental health unit before and after the promulgation of the JCAHO 2000 standards for utilization of S/R for behavioral health reasons.
  
  
  METHODS
  Variables examined include patient acuity, patient census, number of admits, number of discharges, length of stay, number of nursing staff on duty, critical incidents and S/R hours per month.
  
  
  RESULTS
  Results indicated S/R use began showing a notable decrease corresponding to the time that senior unit management began discussions of the new JCAHO standards. These reductions maintained statistical significance even after controlling for changes in unit environmental variables.
authors.affiliation: VA Puget Sound Health Care System, American Lake Division, Mental Health Service, (A-116-R), 9600 Veterans Dr. S.W, Tacoma, WA 98493, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Pollard
authors.forename: Elisia V
authors.initials: EV
authors.lastname: Yanasak
authors.forename: Steven A
authors.initials: SA
authors.lastname: Rogers
authors.forename: André
authors.initials: A
authors.lastname: Tapp
mesh_terms: D000208:Acute Disease; D004637:Emergency Services, Psychiatric / Q000458:organization & administration*; D006291:Health Policy; D006787:Hospitals, Veterans; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D007902:Length of Stay / Q000706:statistics & numerical data; D009737:Nursing Records / Q000706:statistics & numerical data; D010356:Patient Isolation / Q000706:statistics & numerical data*; D011567:Psychiatric Department, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000453:epidemiology / Q000628:therapy*; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D012308:Risk Management / Q000458:organization & administration; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000517:prevention & control; D013647:Task Performance and Analysis; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data; D014754:Violence