Variability in Psychiatric Facility Seclusion and Restraint Rates as Reported on Hospital Compare Site

This study examined variability among U.S. hospitals in rates of seclusion and physical restraint, including the effects of hospital type and ownership, as reported on Hospital Compare. Broader aims were to highlight the wide variability in use of these measures, the need for improved data reporting, and the data source itself, which deserves further development and more attention from regulatory agencies, researchers, and others.

Facility-level data from Hospital Compare for 2013-2017 were analyzed. Rates of seclusion and restraint were computed by aggregating across study years and compared by hospital type and ownership. Rates were also examined by year.

Data cleaning revealed hundreds of errors. The final sample comprised 7,416 seclusion rates and 7,398 restraint rates from 1,642 hospitals. For both acute care and psychiatric hospitals, marked differences were noted in seclusion and restraint rates above the median, with for-profit hospitals reporting markedly lower rates compared with government and nonprofit hospitals. Rates above the median declined substantially during the study period. Although 67% of hospitals reported comparably low rates of seclusion (≤0.09 hours per 1,000 patient-hours) and restraint (≤0.15 hours per 1,000 patient-hours), 10% of hospitals reported rates at least five to 10 times higher.

Despite some progress, many hospitals continue to report very high rates of seclusion and restraint. It is unlikely that this variability can be fully accounted for by patient-level factors. Centers for Medicare and Medicaid Services data reporting should be expanded to include frequency of seclusion and restraint use and duration of episodes.