Changes in Use of Physical Restraints in Intensive Care Unit Patients During the COVID-19 Pandemic

Physical restraints are used in the intensive care unit (ICU) to prevent patient self-harm, but they are also associated with adverse outcomes. The COVID-19 pandemic placed unprecedented challenges on health care systems, especially in ICUs.

To investigate pandemic-associated trends in the use of physical restraints.

In this retrospective pre-post analysis, use of physical restraints in adult ICU patients in a tertiary care center from January 1, 2018, through December 31, 2022, was queried. Patients admitted before March 1, 2020, were deemed the pre-COVID-19 group, and those admitted after were deemed the COVID-19 group. Trends between groups and patient-level risk factors associated with higher physical restraint use were compared.

A total of 17 285 patients were admitted to the ICU during the pre-COVID-19 period, and 20 421 were admitted during the COVID-19 period. Physical restraint use increased significantly from the pre-COVID-19 period to the COVID-19 period (29.4% vs 32.5%; P < .001). Physical restraint use was disproportionately higher among self-identified Black and Hispanic persons than in all others both before and during the COVID-19 period. Additionally, physical restraint use among non-English speakers increased from 30.6% in the pre-COVID-19 period to 38.4% in the COVID-19 period.

Our findings indicate a critical need to understand and address the drivers of increased use of physical restraints during times of stressors on hospital systems. Furthermore, the racial and ethnic disparities in physical restraint use warrant further study and possibly dedicated quality improvement measures.