title: Risk for physical restraint or seclusion in the psychiatric emergency service (PES).
abstract: OBJECTIVE
  We describe risk factors associated with patients experiencing physical restraint or seclusion in the psychiatric emergency service (PES).
  
  
  METHODS
  We retrospectively reviewed medical records, nursing logs and quality assurance data for all adult patient encounters in a PES over a 12-month period (June 1, 2011-May 31, 2012). Descriptors included demographic characteristics, diagnoses, laboratory values, and clinician ratings of symptom severity. χ(2) and multivariate logistic regression analyses were performed.
  
  
  RESULTS
  Restraint/seclusion occurred in 14% of 5335 patient encounters. The following characteristics were associated with restraint/seclusion: arrival to the PES in restraints; referral not initiated by the patient; arrival between 1900 and 0059 hours; bipolar mania or mixed episode; and clinician rating of severe disruptiveness, psychosis or insight impairment. Severe suicidality and a depression diagnosis were associated with less risk of restraint or seclusion.
  
  
  CONCLUSIONS
  Acute symptomatology and characteristics of the encounter were more likely to be associated with restraint/seclusion than patient demographics or diagnoses. These findings support recent guidelines for the treatment of agitation and can help clinicians identify patients at risk of behavioral decompensation.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98195, USA. Electronic address: simpsons@uw.edu.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Simpson
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98195, USA.
authors.forename: Jutta M
authors.initials: JM
authors.lastname: Joesch
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98195, USA.
authors.forename: Imara I
authors.initials: II
authors.lastname: West
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98195, USA.
authors.forename: Jagoda
authors.initials: J
authors.lastname: Pasic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000374:Aggression; D001714:Bipolar Disorder; D015331:Cohort Studies; D003866:Depressive Disorder; D004637:Emergency Services, Psychiatric; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010356:Patient Isolation / Q000706:statistics & numerical data*; D011595:Psychomotor Agitation; D011618:Psychotic Disorders; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D059020:Suicidal Ideation; D013997:Time Factors; D055815:Young Adult
keywords: Agitation; Emergency psychiatry; Physical/mechanical restraint; Seclusion; Violence