Investigating Racial Disparities in Chemical and Physical Restraint of Mental Health Patients in the Emergency Department
Springer Science and Business Media LLC - Trang 1-10 - 2023
Tóm tắt
The primary aim of this study is to examine whether racial disparities exist in the use of physical or chemical restraints in the emergency department (ED). The secondary aim is to explore if there are disparities in type or intensity of restraint. We examined ED encounters for acute mental health crises from a single health system over a 3-year period. Univariate and multivariate logistic regression models were used to examine associations of race/ethnicity with primary outcomes of physical and/or chemical restraint and a measure of restraint intensity among patients physically restrained. The study sample included 18,938 ED encounters with completed psychiatric consultations representing 13,316 unique patients. Restraint use was experienced by one-third of the sample (32.6%): 27.9% chemical restraint, 0.8% physical restraint, 3.9% both physical and chemical. In adjusted logistic regression models, odds of chemical restraint were lower for non-Hispanic (NH) Black (OR 0.83, 95% CI: 0.74, 0.93), NH Asian (OR 0.63, 95% CI: 0.47, 0.83), and Hispanic (OR 0.79, 95% CI: 0.65, 0.95) patients relative to NH White, with no difference for NH American Indian and multiracial. In the models assessing physical restraint use, there were no statistically significant differences by race/ethnicity. Among patients who were physically restrained, there were no differences in the adjusted models of high versus low intensity of the restraint type used. Among ED patients at high risk for restraint, patients of minority race/ethnicity were not found to have increased likelihood of restraint or intensity of restraint.
Tài liệu tham khảo
Schrader CD, Lewis LM. Racial disparity in emergency department triage. J Emerg Med. 2013;44:511–8.
Boley S, Sidebottom A, Vacquier M, Watson D, Olsen J, Echols K, et al. Investigating racial disparities within an emergency department rapid-triage system. Am J Emerg Med. 2022;60:65–72.
Qiao WP, Powell ES, Witte MP, Zelder MR. Relationship between racial disparities in ED wait times and illness severity. Am J Emerg Med. 2016;34:10–5.
Sangal RB, Su H, Khidir H, Parwani V, Liebhardt B, Pinker EJ, et al. Sociodemographic disparities in queue jumping for emergency department care. JAMA Netw Open. 2023;6:e2326338.
Singhal A, Tien Y-Y, Hsia RY. Racial-ethnic disparities in opioid prescriptions at emergency department visits for conditions commonly associated with prescription drug abuse. PLoS One. 2016;11:e0159224.
Boley S, Sidebottom A, Stenzel A, Watson D. Racial disparities in opioid administration practices among undifferentiated abdominal pain patients in the emergency department. J Racial Ethn Health Disparities [Internet]. 2023. https://doi.org/10.1007/s40615-023-01529-1.
Zhang X, Carabello M, Hill T, Bell SA, Stephenson R, Mahajan P. Trends of racial/ethnic differences in emergency department care outcomes among adults in the United States from 2005 to 2016. Front Med. 2020;7:300.
Kuhlman T, Telintelo S, Winget C. Restraint use with emergency psychiatric patients: a new perspective on racial bias. Psychol Rep. 1982;51:343–7.
Telintelo S, Kuhlman TL, Winget C. A study of the use of restraint in a psychiatric emergency room. Psychiatr Serv. 1983;34(2):164–5.
Price TB, David B, Otis D. The use of restraint and seclusion in different racial groups in an inpatient forensic setting. J Am Acad Psychiatry Law. 2004;32:163–8.
Schnitzer K, Merideth F, Macias-Konstantopoulos W, Hayden D, Shtasel D, Bird S. Disparities in care: the role of race on the utilization of physical restraints in the emergency setting. Acad Emerg Med. 2020;27:943–50.
Carreras Tartak JA, Brisbon N, Wilkie S, Sequist TD, Aisiku IP, Raja A, et al. Racial and ethnic disparities in emergency department restraint use: a multicenter retrospective analysis. Acad Emerg Med. 2021;28:957–65.
Nash KA, Tolliver DG, Taylor RA, Calhoun AJ, Auerbach MA, Venkatesh AK, et al. Racial and ethnic disparities in physical restraint use for pediatric patients in the emergency department. JAMA Pediatr. 2021;175:1283–5.
Wong AH, Whitfill T, Ohuabunwa EC, Ray JM, Dziura JD, Bernstein SL, et al. Association of race/ethnicity and other demographic characteristics with use of physical restraints in the emergency department. JAMA Netw Open. 2021;4:e2035241.
Robinson L, Cramer LD, Ray JM, Brashear TK, Agboola IK, Bernstein SL, et al. Racial and ethnic disparities in use of chemical restraint in the emergency department. Acad Emerg Med. 2022;29:1496–9.
Smith CM, Turner NA, Thielman NM, Tweedy DS, Egger J, Gagliardi JP. Association of Black race with physical and chemical restraint use among patients undergoing emergency psychiatric evaluation. Psychiatr Serv. 2022;73:730–6.
Zun LS. A prospective study of the complication rate of use of patient restraint in the emergency department. J Emerg Med. 2003;24:119–24.
Khalid Z, Fana M, Payea R, et al. Disparities and variables associated with physical restraints for acute agitation in a nonpsychiatric emergency department. Prim Care Companion CNS Disord. 2019;21(6):19m02471.