The use of seclusion in emergency medicine

Little is known about the use of seclusion in emergency departments (EDs) across the country. The primary purpose of this study was to determine the extent of the use of seclusion in EDs in the United States. The secondary purpose was to describe seclusion use in EDs.

A survey consisting of questions about the use of seclusion, hospital information, complication rate and related procedures was mailed to a random sample consisting of 20% of the US ED medical directors. The survey was re-mailed to the nonresponders who were also contacted by phone and faxed. The results of the survey were inputted into the SPSS program (SPSS, version 10, Chicago, IL).

The survey was returned by 443 of the 1015, or 43.6% of the ED medical directors in the United States who had been selected. Of the valid 442, 123 (25.6%) use seclusion in their ED. The most frequent reason for not using seclusion was physical plant issues (212 of 422, 50.2%). Most used direct visualization (102 of 187, 54.5%) of seclusion rooms that were locked (54 of 120, 45.0%) and that were overwhelmingly located within the ED (112 of 117, 95.7%). The most frequent reason for placing a patient in seclusion was violence (122 of 126, 96.8%). Both adults (123 of 126, 97.6%) and children (41 of 126, 32.5%) were placed in seclusion rooms. The most frequently reported complication was the patient's getting out of the seclusion room (32 of 106, or 30.1%). Patients were also given chemical restraints (79 of 113, 69.9%). The physician almost always ordered the seclusion room (124 of 125 cases, 99.2%), but the patient was commonly placed in the room by a nurse (109 of 122, 89.3%); generally, the staff had formal training (99 of 122, 81.1%). The use of seclusion was correlated with the number of ED beds (F=32.0, df=1, P=.003), ED volume (F=37.7, df=1, P=.001), number of hospital beds (F=22.6, df=1, P=.001), having a psychiatric unit (F=24.7, df=1, P=.001) and teaching EDs (F=10.8, df=1, P=.001).

Seclusion rooms are used in a minority of EDs across the country. It also identified many outstanding concerns with complications, use in children, addition of chemical sedation, training and seclusion policy.