Reducing Physical Restraint Use in the Medical Behavioral Unit

Area of Science:

• Pediatric Behavioral Health
• Quality Improvement in Healthcare
• Patient Safety

Background:

• Children with behavioral health conditions frequently experience agitation during hospital admissions.
• Physical restraint is a high-risk intervention for agitated patients, potentially harming patients and staff.
• The Medical Behavioral Unit (MBU) sought to reduce its reliance on physical restraints.

Purpose of the Study:

• To decrease the weekly rate of physical restraint events per 100 MBU patient-days from a baseline of 14.0 to below 10 within 12 months.
• To ensure reductions were independent of patient demographics such as race, ethnicity, or language.

Main Methods:

• A multidisciplinary team utilized quality improvement methodology.
• Implemented daily deescalation huddles led by a charge behavioral health clinician for individualized patient planning.
• Tracked weekly physical restraint events per 100 MBU patient-days, restraint duration, and employee injuries.

Main Results:

• The baseline rate of 14.0 physical restraint events per 100 MBU patient-days decreased to 4.1 by December 2022.
• Weekly physical restraint event duration reduced from 112 to 67 minutes.
• No increase in employee injuries was observed during the intervention period.

Conclusions:

• Daily multidisciplinary huddles effectively facilitated deescalation planning.
• These huddles safely and significantly reduced both the frequency and duration of physical restraint events in the MBU.
• The intervention demonstrated a successful quality improvement strategy for managing behavioral health crises in pediatric settings.