title: Reduction of Seclusion and Restraint in an Inpatient Psychiatric Setting: A Pilot Study.
abstract: The authors describe a quality and safety initiative designed to decrease seclusion/restraint (S/R) and present the results of a pilot study that evaluated the effectiveness of this program. The study sample consisted of consecutive admissions to a 120-bed psychiatric service after the intervention was implemented (October 2010-September 2012, n = 8029). Analyses compared S/R incidence and duration in the study sample to baseline (consecutive admissions during the year prior to introduction of the intervention, October 2008-September 2009, n = 3884). The study intervention, which used evidence-based therapeutic practices for reducing violence/aggression, included routine use of the Brøset Violence Checklist, mandated staff education in crisis intervention and trauma informed care, increased frequency of physician reassessment of need for S/R, formal administrative review of S/R events and environmental enhancements (e.g., comfort rooms to support sensory modulation). Statistically significant associations were found between the intervention and a decrease in both the number of seclusions (p < 0.01) and the duration of seclusion per admission (p < 0.001). These preliminary results support the conclusion that this intervention was effective in reducing use of seclusion. Further study is needed to determine if these prevention strategies are generalizable, the degree to which each component of the intervention contributes to improve outcome, and if continuation of the intervention will further reduce restraint use.
authors.affiliation: The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA. ellen.blair@hhchealth.org.
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Blair
authors.affiliation: Burlingame Center for Psychiatric Research and Education, The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Woolley
authors.affiliation: The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA.
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Szarek
authors.affiliation: The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA.
authors.forename: Theodore F
authors.initials: TF
authors.lastname: Mucha
authors.affiliation: The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA.
authors.forename: Olga
authors.initials: O
authors.lastname: Dutka
authors.affiliation: The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA.
authors.forename: Harold I
authors.initials: HI
authors.lastname: Schwartz
authors.affiliation: Burlingame Center for Psychiatric Research and Education, The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Wisniowski
authors.affiliation: Burlingame Center for Psychiatric Research and Education, The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Goethe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000374:Aggression; D057189:Checklist; D002648:Child; D002985:Clinical Protocols; D003221:Confusion; D003419:Crisis Intervention / Q000193:education; D019317:Evidence-Based Medicine; D005260:Female; D006760:Hospitalization; D006801:Humans; D007508:Irritable Mood; D008297:Male; D008875:Middle Aged; D010356:Patient Isolation / Q000706:statistics & numerical data*; D061214:Patient Safety; D010564:Personnel, Hospital / Q000193:education; D010865:Pilot Projects; D015397:Program Evaluation; D011567:Psychiatric Department, Hospital; D000067073:Psychological Trauma; D058996:Quality Improvement; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D014754:Violence / Q000517:prevention & control*; D055815:Young Adult
keywords: Brøset Violence Checklist; Psychiatric inpatients; Restraint; Seclusion; Trauma informed care