Code De-Escalation: Decreasing restraint use during agitation management in a community hospital emergency department

Dana D. Im,Alice K. Bukhman, Josh W. Joseph, Jim C. Dziobek, Jill Grant, Kathleen C. Clifford, Inkyu Kim,Paul C. Chen,Naomi A. Schmelzer, Robin Powell, Beth Waters, Andrew Dundin, Noah Askman, Terrance Lassiter, Da'Marcus E. Baymon, Kalpana Shankar,Leon D. Sanchez

The American Journal of Emergency Medicine(2024)

引用 0|浏览4
暂无评分
摘要
Introduction: Restraint use in the emergency department (ED) can pose significant risks to patients and health care workers. We evaluate the effectiveness of Code De-escalation- a standardized, team-based approach for management and assessment of threatening behaviors- in reducing physical restraint use and workplace violence in a community ED. Methods: A retrospective observational study of a pathway on physical restraint use among patients placed on an involuntary psychiatric hold in a community ED. This pathway includes a built-in step for the team members to systematically assess perceptions of threats from the patient behavior and threats perceived by the patient. Our primary outcome was the change in the rate of physical restraint use among patients on an involuntary psychiatric hold. Our secondary outcome was the change in the rate of workplace violence events involving all ED encounters. We evaluated our outcomes by comparing all encounters in a ten-month period before and after implementation, and compared our results to rates at neighboring community hospitals within the same hospital network. Results: Pre intervention there were 434 ED encounters involving a psychiatric hold, post-intervention there were 535. We observed a significant decrease in physical restraint use, from 7.4% to 3.7% (ARR 0.028 [95% CI 0.002-0.055], p < 0.05). This was not seen at the control sites. Conclusions: A standardized de-escalation algorithm can be effective in helping ED's decrease their use of physical restraints in management of psychiatric patients experiencing agitation.
更多
查看译文
关键词
Agitation management,Restraint,Physical restraint,Acute agitation,Workplace violence
AI 理解论文
溯源树
样例
生成溯源树,研究论文发展脉络
Chat Paper
正在生成论文摘要