Using a Behavior Assessment Tool to Decrease Restraint Use in the Emergency Department

Behavioral health visits to emergency departments have increased, increasing the risk of patient violent agitation that may require restraints to control. Our objective was to determine whether using the Behavioral Activity Rating Scale and treatment recommendations matched to patient scores would affect the number of patients who required physical restraints during their stay in the emergency department.

In this quality improvement project, nursing performed Behavioral Activity Rating Scale assessments on all behavioral health patients who presented to the emergency department, occurring during triage and at regular intervals with vital signs. Data were collected for a period before implementation and compared with data collected after implementing the Behavioral Activity Rating Scale workflow. Patients who required restraints during their stay, patients who required 2 or more restraints during their stay, and timing of restraint application were analyzed.

Results show a decrease in the number of patients who required restraints during their ED stay, decreasing from a rate of 8.7% to 7.0% (P = .02). There was also a decrease in the number of patients who required multiple restraints, from a rate of 82.2% to 27.2% (P < .001). There was no difference in the number of patients who required restraints 1 hour after their arrival before versus after intervention (P = .40).

Early recognition of patient agitation is essential in appropriate treatment of that agitation. The Behavioral Activity Rating Scale assessment is an effective tool to quantify a patient's agitation level. When coupled with treatment recommendations or protocols, it may decrease restraint use in the emergency department.