Physical Restraint Use in Hospitalized Patients: A Study of Routinely Collected Health Records Data.

Area of Science:

• Healthcare research
• Patient safety
• Clinical informatics

Background:

• Hospitalized patient restraint use poses risks to patients and staff.
• Minimizing restraint use is a critical hospital objective.
• Accurate assessment of restraint patterns is essential for reduction strategies.

Purpose of the Study:

• To determine the rate of physical restraint use in a healthcare network.
• To analyze restraint rates by care context, diagnosis, and demographics.
• To evaluate the accuracy of ICD-10 code Z78.1 for identifying physical restraints.

Main Methods:

• Retrospective analysis of adult hospitalizations from 2017-2022 using electronic health records (EHR).
• Data collected included demographics, diagnoses, care area, length of stay, mortality, and restraint documentation.
• Comparison of ICD-10 code Z78.1 against EHR orders and flowsheets for restraint status.

Main Results:

• 6.3% of 742,607 hospitalizations involved physical restraints.
• Intensive care unit (ICU) patients had a 39% restraint rate versus 1.3% in other areas.
• Increased odds of restraint were linked to male gender, older age, unknown race, and non-English language; ICD-10 code Z78.1 had 1.5% sensitivity and 99.99% specificity.

Conclusions:

• Clinical, demographic, and operational factors influence physical restraint use in hospitals.
• Intensive care unit (ICU) care significantly increases the likelihood of restraint.
• The low sensitivity of ICD-10 code Z78.1 limits research relying on administrative claims data for restraint utilization.