Characteristics of Patients With Histories of Multiple Seclusion and Restraint Events During a Single Psychiatric Hospitalization

BACKGROUND: This descriptive, retrospective study examined patient and event characteristics associated with multiple seclusion and restraint (SR). OBJECTIVE: The goal was to identify patient characteristics of multiple seclusion and restraint users to improve patient care and decrease the need for seclusion or restraint. DESIGN: Medical charts were reviewed for 63 patients hospitalized at the Henry Phipps Psychiatric Service at the Johns Hopkins Hospital between January 2006 and December 2008 who had been secluded or restrained multiple times during a single hospitalization. Patient characteristics and events associated with multiple SR use were examined. Characteristics were then compared with those who had a single (n = 110) and no SR events (n = 3,585) during hospitalization in those study years. RESULTS: Compared with patients with no SR events, those with multiple SR events were more likely to be male, have histories of aggression before and during previous hospitalizations, and have longer lengths of stay. Patients with any SR event were more likely to have cognitive impairment and have been admitted involuntarily. CONCLUSIONS: Results highlight the need for practice changes targeting subgroups of patients at elevated risk for multiple SR use.