ArticlesDecreasing the Use of Restraint and Seclusion Among Psychiatric InpatientsHELLERSTEIN, DAVID J. MD; STAUB, AMY BENNETT RN, MPA; LEQUESNE, ELIZABETH MDAuthor Information HELLERSTEIN and LEQUESNE: New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons; STAUB: New York State Psychiatric Institute, New York, NY. Please send correspondence and reprint requests to: David J. Hellerstein, MD, Harkness Pavilion, Room #HP256, 180 Fort Washington Ave., New York, NY 10032. [email protected] Journal of Psychiatric Practice: September 2007 - Volume 13 - Issue 5 - p 308-317 doi: 10.1097/01.pra.0000290669.10107.ba Buy Metrics Abstract Objective. We describe a hospital-wide effort to decrease restraint and seclusion of psychiatric inpatients. Our hypotheses were that interventions could reduce the number of patients as well as patient hours in restraint and seclusion, without an increase in adverse outcomes (fights/assaults, staff injuries, and elopements). Method. This study was performed at an urban academic psychiatric hospital (New York State Psychiatric Institute) with 3 inpatient units totaling 58 beds. Interventions included 1) decreasing initial time in restraint or seclusion from 4 to 2 hours before a new order was required; 2) education of staff concerning identification of patients at risk of restraint or seclusion and early interventions to avoid crises; and 3) use of a coping questionnaire to assess patient preferences for dealing with agitation. Data were assessed 20 months before and 67 months following the implementation of these interventions. Results. The mean number of patients restrained went from 0.35 ± 0.6 to 0.32 ± 0.5 patients/month; mean hours of restraint decreased from 1.7 ± 5.2 to 1.0 ± 2.4 hours/month. The mean number of patients secluded decreased significantly from 3.1 ± 1.4 to 1.0 ± 1.1 patients/month. The mean hours of seclusion decreased markedly, from 41.6 ± 52 to 2.7 ± 4.5 hours/month. Adverse outcomes (elopements and fights/assaults) also decreased significantly over the follow-up period. Conclusions. Interventions were successful in decreasing use of restraint and seclusion on both clinical and research units over more than 5 years of follow-up. Such interventions may be adapted to other settings. Copyright © 2007 Wolters Kluwer Health, Inc. All rights reserved.