title: Seclusion and restraint as measures of the quality of hospital care: any exceptions?
abstract: The Joint Commission has recently included seclusion and restraint as quality-of-care indicators for hospital-based inpatient psychiatric services. Their inclusion is the result of abuse of these practices, wide variation across hospitals, and cultural influences, including the consumer and recovery movements. Over the next few years, these indicators will increasingly influence treatment modalities available to hospitalized patients. This Open Forum provides a brief history of changing attitudes toward use of seclusion and restraint. It describes three clinical scenarios that highlight appropriate and humane use of seclusion and restraint and that illustrate the clinical complexities associated with their use. Potential unforeseen consequences of the reduction or elimination of seclusion and restraint are described.
authors.affiliation: Dr. Sacks is with the Department of Psychiatry, New York-Presbyterian Hospital, New York City. Dr. Walton is with the Department of Psychiatry, NYU Langone Medical Center, New York University, New York City. Send correspondence to Dr. Walton (e-mail: michael.walton@nyumc.org ).
authors.forename: Michael H
authors.initials: MH
authors.lastname: Sacks
authors.forename: Michael F
authors.initials: MF
authors.lastname: Walton
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006778:Hospitals, Psychiatric / Q000592:standards; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D010356:Patient Isolation / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D059020:Suicidal Ideation