The following is a summary of “Code De-Escalation: Decreasing restraint use during agitation management in a community hospital emergency department,” published in the February 2024 issue of Emergency Medicine by Im, et al.

Using restraints in the emergency department (ED) presents notable risks to patients and healthcare workers. For a study, researchers sought to assess the efficacy of Code De-escalation, a standardized team-based approach designed for managing and evaluating threatening behaviors, in reducing the use of physical restraints and incidents of workplace violence in a community ED setting.

A retrospective observational study was conducted to evaluate the impact of a pathway on physical restraint use among patients placed on involuntary psychiatric holds in a community ED. The pathway incorporated a systematic approach for team members to assess perceptions of threats from patient behavior and threats perceived by the patient. The primary outcome measure was the change in the rate of physical restraint use among patients on involuntary psychiatric holds. The secondary outcome was the change in the rate of workplace violence events involving all ED encounters. Outcomes were compared between ten months before and after pathway implementation, and results were compared to rates at neighboring community hospitals within the same hospital network.

Before the intervention, there were 434 ED encounters involving a psychiatric hold, whereas post-intervention, there were 535. A significant decrease in physical restraint use was observed, from 7.4% to 3.7% (ARR 0.028 [95% CI 0.002–0.055], P < 0.05). The reduction was not observed at the control sites.

The implementation of a standardized de-escalation algorithm has demonstrated effectiveness in reducing the use of physical restraints in the management of psychiatric patients experiencing agitation within ED settings.

Reference: sciencedirect.com/science/article/abs/pii/S073567572300671X