Association between ward structural changes and coercive interventions in psychiatric emergency wards in Japan: a...

Seclusion and physical restraint (PR) are sometimes required in psychiatric emergency wards for safety, but reducing their use is a key clinical and ethical objective. Although ward features such as private rooms are believed to affect coercive practices, empirical evidence remains limited.

In April 2020, Hospital A's psychiatric emergency ward relocated to Hospital B, with a slightly reduced bed capacity (46 to 42 beds), increased private rooms, expanded closed-circuit television (CCTV) monitoring, and a centralised staff station. We retrospectively analysed 816 admissions (Hospital A: n = 372; Hospital B: n = 444) before and after relocation. Primary outcomes were seclusion and PR use; secondary outcomes included event count, duration, and days from open observation to termination. Analyses used logistic regression and generalized linear mixed models (GLMMs).

Hospital B had fewer patients subjected to seclusion (n = 155) and PR (n = 94). Multivariable analyses showed lower odds of seclusion (odds ratio [OR] = 0.70, 95% confidence interval [CI]: 0.50-0.99) and PR (OR = 0.65, 95% CI: 0.46-0.92). GLMMs showed shorter seclusion duration (β = - 0.281, p < 0.05) and faster transition from observation to termination (β = - 0.386, p < 0.01). PR duration did not differ significantly.

Ward structural changes may reduce coercive interventions.