Agitation Management in the Emergency Department with Physical Restraints: Where Do These Patients End Up?
Introduction: Agitation is frequently encountered in the emergency department (ED) and can range from psychomotor restlessness to overt aggression and violent behavior. Among all ED patients, 2.6% present with agitation or become agitated during their ED visit. We aimed to determine ED disposition f...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2023-05-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/5c5326nx |
| _version_ | 1797798210761129984 |
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| author | Erin L. Simon Courtney M. Smalley McKinsey Muir Caroline Mangira Mangira Rylee Pence Bhanu Wahi-Singh Fernando Delgado Baruch S. Fertel |
| author_facet | Erin L. Simon Courtney M. Smalley McKinsey Muir Caroline Mangira Mangira Rylee Pence Bhanu Wahi-Singh Fernando Delgado Baruch S. Fertel |
| author_sort | Erin L. Simon |
| collection | DOAJ |
| description | Introduction: Agitation is frequently encountered in the emergency department (ED) and can range from psychomotor restlessness to overt aggression and violent behavior. Among all ED patients, 2.6% present with agitation or become agitated during their ED visit. We aimed to determine ED disposition for patients requiring agitation management with physical restraints. Methods: This was a retrospective cohort of all adult patients who presented to one of 19 EDs in a large integrated healthcare system and received agitation management with physical restraints between January 1, 2018–December 31, 2020. Categorical variables are presented as frequency and percentages, and continuous variables are presented as medians and interquartile range. Results: There were 3,539 patients who had agitation management with physical restraints included in this study. In total 2,076 (58.8%) were admitted to the hospital (95% CI [confidence interval] 0.572–0.605), and of those 81.4% were admitted to a primary medical floor and 18.6% were medically cleared and admitted to a psychiatric unit. Overall, 41.2% were able to be medically cleared and discharged from the ED. Mean age was 40.9 years, 2,140 were male (59.1%), 1,736 were White (50.3%), and 1,527 (43%) were Black. We found 26% had abnormal ethanol, (95% CI 0.245–0.274) and 54.6% had an abnormal toxicology screen (95% CI 0.529–0.562). A significant number were administered a benzodiazepine or antipsychotic in the ED (88.44%) (95% CI 0.874–0.895). Conclusion: The majority of patients who had agitation management with physical restraints were admitted to the hospital; of those patients, 81.4% were admitted to a primary medical floor and 18.6% were admitted to a psychiatric unit. |
| first_indexed | 2024-03-13T04:00:03Z |
| format | Article |
| id | doaj.art-805b8c51c5f445378ef4795ac2ba8190 |
| institution | Directory Open Access Journal |
| issn | 1936-9018 |
| language | English |
| last_indexed | 2024-03-13T04:00:03Z |
| publishDate | 2023-05-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-805b8c51c5f445378ef4795ac2ba81902023-06-21T18:00:40ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-90182023-05-0124310.5811/westjem.59466wjem-24-454Agitation Management in the Emergency Department with Physical Restraints: Where Do These Patients End Up?Erin L. Simon0Courtney M. Smalley1McKinsey Muir2Caroline Mangira Mangira3Rylee Pence4Bhanu Wahi-Singh5Fernando Delgado6Baruch S. Fertel7Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OhioCleveland Clinic Emergency Services Institute, Cleveland, OhioCleveland Clinic, Patient Quality and Safety, Cleveland, OhioCleveland Clinic Akron General, Department of Emergency Medicine, Akron, OhioCleveland Clinic Akron General, Department of Emergency Medicine, Akron, OhioCleveland Clinic Akron General, Department of Emergency Medicine, Akron, OhioCleveland Clinic, Patient Quality and Safety, Cleveland, OhioCleveland Clinic, Patient Quality and Safety, Cleveland, OhioIntroduction: Agitation is frequently encountered in the emergency department (ED) and can range from psychomotor restlessness to overt aggression and violent behavior. Among all ED patients, 2.6% present with agitation or become agitated during their ED visit. We aimed to determine ED disposition for patients requiring agitation management with physical restraints. Methods: This was a retrospective cohort of all adult patients who presented to one of 19 EDs in a large integrated healthcare system and received agitation management with physical restraints between January 1, 2018–December 31, 2020. Categorical variables are presented as frequency and percentages, and continuous variables are presented as medians and interquartile range. Results: There were 3,539 patients who had agitation management with physical restraints included in this study. In total 2,076 (58.8%) were admitted to the hospital (95% CI [confidence interval] 0.572–0.605), and of those 81.4% were admitted to a primary medical floor and 18.6% were medically cleared and admitted to a psychiatric unit. Overall, 41.2% were able to be medically cleared and discharged from the ED. Mean age was 40.9 years, 2,140 were male (59.1%), 1,736 were White (50.3%), and 1,527 (43%) were Black. We found 26% had abnormal ethanol, (95% CI 0.245–0.274) and 54.6% had an abnormal toxicology screen (95% CI 0.529–0.562). A significant number were administered a benzodiazepine or antipsychotic in the ED (88.44%) (95% CI 0.874–0.895). Conclusion: The majority of patients who had agitation management with physical restraints were admitted to the hospital; of those patients, 81.4% were admitted to a primary medical floor and 18.6% were admitted to a psychiatric unit.https://escholarship.org/uc/item/5c5326nx |
| spellingShingle | Erin L. Simon Courtney M. Smalley McKinsey Muir Caroline Mangira Mangira Rylee Pence Bhanu Wahi-Singh Fernando Delgado Baruch S. Fertel Agitation Management in the Emergency Department with Physical Restraints: Where Do These Patients End Up? Western Journal of Emergency Medicine |
| title | Agitation Management in the Emergency Department with Physical Restraints: Where Do These Patients End Up? |
| title_full | Agitation Management in the Emergency Department with Physical Restraints: Where Do These Patients End Up? |
| title_fullStr | Agitation Management in the Emergency Department with Physical Restraints: Where Do These Patients End Up? |
| title_full_unstemmed | Agitation Management in the Emergency Department with Physical Restraints: Where Do These Patients End Up? |
| title_short | Agitation Management in the Emergency Department with Physical Restraints: Where Do These Patients End Up? |
| title_sort | agitation management in the emergency department with physical restraints where do these patients end up |
| url | https://escholarship.org/uc/item/5c5326nx |
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