Heterogeneity, equifinality and risk: Profiles of restrained patients presenting to a general medical hospital

Physical restraints refer to the immobilization of patient movement to address safety concerns or manage treatment interference. Interventions to reduce restraints have been effective in long-term care and psychiatric facilities. In contrast, rates of restraint have increased in general medical hospitals, possibly because of high patient volume and heterogenous patient populations. This high level of heterogeneity makes it difficult to develop preventative interventions. The current study aims to address this heterogeneity by generating profiles of restrained patients.

Latent class analysis (LCA) was conducted using hospital data incorporating demographic and clinical variables to identify restrained patient subgroups, then class membership was used to examine differences in contextual factors and characteristics of restraint episodes.

Five classes were identified: (1) Men with high-risk alcohol use and traumatic head injuries; (2) men in acute physical and mental distress with psychiatric comorbidities; (3) middle-aged men with severe medical conditions and histories of substance use disorders; (4) older male and female patients with severe medical illness and comorbid neurological impairments; (5) relatively young, black patients with psychiatric conditions and comorbid substance use. Classes were found to differ in terms of the reasons for restraint and the settings in which restraints occurred.

The current study extends previous findings and is the first to examine profiles of restrained patients across a general medical hospital. These profiles are recognizable to clinicians and readily derived from available data, facilitating more rapid classification of patients.These data could guide the development of tailored interventions to reduce restraint use.