• James Luccarelli, Tsu K Gan, Sara B Golas, Poorvi Sriraman, Colleen K Snydeman, Chana A Sacks, and Thomas H McCoy.
• Massachusetts General Hospital, 32 Fruit Street, Yawkey 6A, Boston, MA, 02114, USA. jluccarelli@mgb.org.
• J Gen Intern Med. 2024 Oct 10.

BackgroundThe use of restraints in hospitalized patients is associated with physical and psychological adversity for patients and staff. The minimization of restraint use is a key goal in the hospital setting. Reaching this goal requires an accurate assessment of existing patterns of use across clinical settings.ObjectiveThis study reports the rate of physical restraints among patients hospitalized within a multi-entity healthcare network along with stratification by care context, diagnostic, and demographic factors, and examines the sensitivity and specificity of ICD-10 code Z78.1 "physical restraint status" for defining physical restraints relative to electronic health record (EHR) documentation.DesignThe EHR was used for a retrospective analysis of all adults hospitalized between 2017 and 2022.ParticipantsHospitalized adults.Main MeasuresPatient demographics, structured diagnostic information, care area, length of stay, and in-hospital mortality, Z78.1 coding for physical restraints, restraint documentation in orders and flowsheets.Key ResultsAmong 742,607 hospitalizations, 6.3% (n=47,041) involved the use of physical restraint based on coding or EHR documentation. Treatment in the intensive care unit (ICU) included restraint in 39% of encounters whereas treatment outside the ICU included restraint use in 1.3% of encounters. Besides critical illness, demographic factors including increasing age (adjusted odds ratio (aOR)=1.21 [1.19-1.23]), male gender (aOR=1.56, [1.52-1.60]), unknown race (aOR=1.27 [1.19-1.35]), and preferred language other than English (aOR=1.24, [1.18-1.29]) were associated with higher odds of restraint utilization. As compared to EHR orders or documentation of restraint, the ICD-10 code for physical restraint had a sensitivity of 1.5% and a specificity of 99.99%.ConclusionAmong adults admitted to acute care hospitals, clinical, demographic, and operational factors were associated with increased odds of restraint, with care in the ICU associated with greatly increased odds of restraint. Research into restraint utilization using coded administrative claims data is likely limited by the sensitivity of physical restraint coding.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

4 keywords...

hide…