Prevalence, Risk Factors and Outcomes Associated with Physical Restraint in Acute Medical Inpatients over 4 Years—A Retrospective Cohort Study
Abstract
:1. Introduction
2. Methods
2.1. Inclusion and Exclusion Criteria
2.2. Outcomes
2.3. Data Collection
2.4. Statistical Analysis
3. Results
3.1. Patient Cohort
3.2. Association of Physical Restraints and Outcome
3.3. Indication for the Use of Restraint and Medical Therapy
3.4. Trends over Time
4. Discussion
4.1. LOS and Nurses’ Time Expenditure
4.2. Comparing Fall and Type of Restraints
4.3. Differences between Wards of the Same Clinic
4.4. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Factor | Overall | Without Restraints | With Restraints | p-Value ¶ |
---|---|---|---|---|
n = 11,979 (100%) | n = 11,207 (93.6%) | n = 772 (6.4%) | ||
Age, years | 68 (±16) | 68 (±16) | 78 (±12) | <0.001 |
Female gender | 5257 (43.9%) | 4937 (44.1%) | 320 (41.5%) | 0.16 |
Elixhauser CMI | 9.1 (±8.5) | 8.8 (±8.4) | 12.6 (±8.8) | <0.001 |
DOS points | 0.8 (±1.7) | 0.6 (±1.3) | 3.3 (±2.3) | <0.001 |
DOS compliance * | 972 (92.2%) | 762 (91.9%) | 210 (93.3%) | 0.48 |
Major disease (ICD-10 Code) | ||||
Diseases of the circulatory system | 3339 (27.9%) | 3169 (28.3%) | 170 (22.0%) | |
Diseases of the respiratory system | 1861 (15.5%) | 1737 (15.5%) | 124 (16.1%) | |
Neoplasms | 1759 (14.7%) | 1635 (14.6%) | 124 (16.1%) | |
Diseases of the digestive system | 1245 (10.4%) | 1178 (10.5%) | 67 (8.7%) | |
Certain infectious and parasitic diseases | 1026 (8.6%) | 946 (8.4%) | 80 (10.4%) | |
Diseases of the nervous system | 566 (4.7%) | 508 (4.5%) | 58 (7.5%) | |
Diseases of the genitourinary system | 524 (4.4%) | 482 (4.3%) | 42 (5.4%) | |
Disease of connective tissue | 534 (4.5%) | 519 (4.6%) | 15 (1.9%) | |
Endocrine, nutritional and metabolic diseases | 343 (2.9%) | 324 (2.9%) | 19 (2.5%) | |
Mental and behavioral disorders | 219 (1.8%) | 165 (1.5%) | 54 (7.0%) | |
Others | 563 (4.7%) | 544 (4.9%) | 19 (2.5%) | <0.001 |
Place of discharge | ||||
Outpatient care | 8662 (72.3%) | 8340 (74.4%) | 322 (41.7%) | |
Rehabilitation facility | 2637 (22.0%) | 2290 (20.4%) | 347 (44.9%) | |
Year of admission | ||||
2018 | 2964 (24.7%) | 2815 (25.1%) | 149 (19.3%) | 0.004 |
2019 | 3154 (26.3%) | 2943 (26.3%) | 211 (27.3%) | |
2020 | 3034 (25.3%) | 2823 (25.2%) | 211 (27.3%) | |
2021 | 2827 (23.6%) | 2626 (23.4%) | 201 (26.0%) | |
LOS, days | 6 (4–9) | 5 (3–9) | 8 (5–14) | <0.001 |
Nurses’ time expenditure, hours per admission | 187 (13–255) | 182 (136–243) | 309 (242–402) | <0.001 |
In-hospital death | 680 (5.7%) | 577 (5.1%) | 103 (13.3%) | <0.001 |
Without Restraints | With Restraints | Blanket Restrictions | Belts | Bedrails | Sensor Mats | |
---|---|---|---|---|---|---|
n = 11,207 (98.3%) | n = 772 (1.7%) | n = 132 (17.1%) | n = 34 (4.4%) | n = 80 (10.4%) | n = 666 (86.3%) | |
Female gender | 4937 (44.1%) | 320 (41.5%) | 54 (40.9%) | 6 (18%) | 39 (49%) | 280 (42.0%) |
DOS points | 0.6 (±1.3) | 3.3 (±2.3) | 4.6 (±2.5) | 4.3 (±2.5) | 4.6 (±2.4) | 3.1 (±2.1) |
DOS compliance | 762 (91.9%) | 210 (93.3%) | 35 (95%) | 5 (71%) | 17 (100%) | 188 (93.5%) |
Year of admission | ||||||
2018 | 2815 (25.1%) | 149 (19.3%) | 32 (24.2%) | 14 (41%) | 27 (34%) | 112 (16.8%) |
2019 | 2943 (26.3%) | 211 (27.3%) | 45 (34.1%) | 10 (29%) | 18 (23%) | 185 (27.8%) |
2020 | 2823 (25.2%) | 211 (27.3%) | 33 (25.0%) | 6 (18%) | 21 (26%) | 185 (27.8%) |
2021 | 2626 (23.4%) | 201 (26%) | 22 (16.7%) | 4 (12%) | 14 (18%) | 184 (27.6%) |
Place of discharges | ||||||
Outpatient care | 8340 (74.4%) | 322 (41.7%) | 39 (29.5%) | 8 (24%) | 28 (35%) | 286 (42.9%) |
Rehabilitation facility | 2290 (20.4%) | 347 (44.9%) | 70 (53.0%) | 19 (56%) | 34 (43%) | 300 (45.0%) |
Clinical outcomes | ||||||
LOS, days | 5 (3–9) | 8 (5–14) | 8 (5.5–15) | 13 (6–21) | 11 (6–18) | 8 (5–13) |
Nurses’ time expenditure hours, hours per admission | 182 (136–243) | 309 (242–402) | 341 (266–447) | 344 (255–472) | 376 (288–476) | 304 (238–393) |
Fall without restraint or after start of a restraint | 300 (2.7%) | 174 (22.5%) | 35 (26.5%) | 11 (32%) | 29 (36%) | 146 (21.9%) |
Time difference between fall and restraint, hours * | N/A | −19 (±161) | −20 (±151) | −96 (±191) | −34 (±195) | −22 (±168) |
Fall during first restraint use | N/A | 46 (6.0%) | 7 (5.3%) | 0 (0%) | 7 (9%) | 39 (5.9%) |
Restraint duration per total counts of restraints, hours | N/A | 42 (±57) | 25 (±23) | 18 (±21) | 58 (±102) | 42 (±51) |
In-hospital death | 577 (5.1%) | 103 (13.3%) | 23 (17.4%) | 7 (21%) | 18 (23%) | 80 (12.0%) |
Outcomes | Nurses’ Time Expenditure, Hours per Admission | LOS, Days | Fall | In-Hospital Death | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Variables | β | 95% CI | p-Value | β | 95% CI | p-Value | OR | 95% CI | p-Value | OR | 95% CI | p-Value |
Physical restraint yes vs. no | 96.29 | 87.12–105.45 | <0.01 | 2.81 | 2.31–3.31 | <0.01 | 8.85 | 6.85–11.45 | <0.01 | 1.92 | 1.49–2.48 | <0.01 |
Constant/Baseline | 12.12 | −0.65–24.89 | 0.06 | 4.28 | 3.58–4.98 | <0.01 | 0.005 | 0.002–0.01 | <0.01 | 0.001 | 0.001–0.003 | <0.01 |
Age, years | 1.67 | 1.52–1.82 | <0.01 | 0.01 | 0.005–0.02 | <0.01 | 1.02 | 1.01–1.03 | <0.01 | 1.04 | 1.03–1.05 | <0.01 |
Female, gender | 7.18 | 2.75–11.61 | <0.01 | −0.19 | −0.44–0.05 | 0.12 | 0.86 | 0.68–1.09 | 0.21 | 0.94 | 0.79–1.11 | 0.47 |
Elixhauser CMI | 18.76 | 16.31–21.21 | <0.01 | 1.57 | 1.43–1.70 | <0.01 | 1.45 | 1.32–1.60 | <0.01 | 1.37 | 1.27–1.47 | <0.01 |
Year of admission | ||||||||||||
2018 | Ref. | Ref. | Ref. | Ref. | ||||||||
2019 | 3.13 | −2.85–9.10 | 0.31 | 0.02 | −0.32–0.35 | 0.92 | 0.75 | 0.55–1.02 | 0.07 | 0.93 | 0.73–1.18 | 0.53 |
2020 | 30.66 | 24.67–36.65 | <0.01 | −0.30 | −0.63–0.04 | 0.08 | 0.74 | 0.54–1.01 | 0.06 | 0.85 | 0.66–1.08 | 0.17 |
2021 | 30.15 | 23.70–36.61 | <0.01 | −0.003 | −0.35–0.34 | 0.98 | 0.73 | 0.53–1.01 | 0.06 | 1.08 | 0.85–1.37 | 0.51 |
Major disease (ICD-10 Code) | ||||||||||||
Diseases of the circulatory system | Ref. | Ref. | Ref. | Ref. | ||||||||
Diseases of the respiratory system | 75.18 | 69.10–81.27 | <0.01 | 0.77 | 0.44–1.11 | <0.01 | 1.22 | 0.87–1.72 | 0.25 | 1.58 | 1.21–2.05 | <0.01 |
Neoplasms | 52.31 | 45.78–58.85 | <0.01 | 3.37 | 3.02–3.73 | <0.01 | 2.12 | 1.56–2.88 | <0.01 | 3.77 | 2.99–4.77 | <0.01 |
Diseases of the digestive system | 49.66 | 42.70–56.62 | <0.01 | 0.49 | 0.11–0.87 | 0.01 | 0.84 | 0.54–1.30 | 0.43 | 0.77 | 0.53–1.13 | 0.19 |
Certain infectious and parasitic diseases | 81.98 | 74.50–89.45 | <0.01 | 1.19 | 0.78–1.59 | <0.01 | 1.19 | 0.79–1.79 | 0.40 | 2.75 | 2.09–3.60 | <0.01 |
Class of insurance | −13.00 | −19.75–(−6.25) | <0.01 | −0.37 | −0.74–0.01 | 0.05 | 1.02 | 0.73–1.44 | 0.89 | 0.94 | 0.73–1.21 | 0.65 |
Medical Wards | ||||||||||||
1 | Ref. | Ref. | Ref. | Ref. | ||||||||
2 | 23.52 | 16.33–30.71 | <0.01 | −0.31 | −0.70–0.08 | 0.12 | 1.02 | 0.68–1.53 | 0.91 | 1.25 | 0.93–1.69 | 0.14 |
3 | 2.67 | −4.62–9.96 | 0.47 | 0.35 | −0.05–0.75 | 0.09 | 1.18 | 0.79–1.77 | 0.43 | 1.07 | 0.79–1.45 | 0.67 |
4 | 3.05 | −5.98–12.08 | 0.51 | 0.76 | 0.27–1.24 | <0.01 | 1.20 | 0.75–1.92 | 0.44 | 1.09 | 0.78–1.54 | 0.61 |
5 | 0.83 | −7.266–8.92 | 0.84 | 0.35 | −0.09–0.79 | 0.12 | 1.17 | 0.76–1.82 | 0.48 | 1.24 | 0.90–1.72 | 0.19 |
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Spennato, U.; Lerjen, N.; Siegwart, J.; Mueller, B.; Schuetz, P.; Koch, D.; Struja, T. Prevalence, Risk Factors and Outcomes Associated with Physical Restraint in Acute Medical Inpatients over 4 Years—A Retrospective Cohort Study. Geriatrics 2023, 8, 15. https://doi.org/10.3390/geriatrics8010015
Spennato U, Lerjen N, Siegwart J, Mueller B, Schuetz P, Koch D, Struja T. Prevalence, Risk Factors and Outcomes Associated with Physical Restraint in Acute Medical Inpatients over 4 Years—A Retrospective Cohort Study. Geriatrics. 2023; 8(1):15. https://doi.org/10.3390/geriatrics8010015
Chicago/Turabian StyleSpennato, Umberto, Nathalie Lerjen, Jennifer Siegwart, Beat Mueller, Philipp Schuetz, Daniel Koch, and Tristan Struja. 2023. "Prevalence, Risk Factors and Outcomes Associated with Physical Restraint in Acute Medical Inpatients over 4 Years—A Retrospective Cohort Study" Geriatrics 8, no. 1: 15. https://doi.org/10.3390/geriatrics8010015