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Article   |    
Hospital Characteristics, Diagnoses, and Staff Reasons Associated With Use of Seclusion and Restraint
Elizabeth J. Betemps; Eugene Somoza; C. Ralph Buncher
Psychiatric Services 1993; doi:
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This project was supported by the Health Services Research and Development Service of the Department of Veterans Affairs, the Cincinnati VA Medical Center, and the University of Cincinnati.

University of Cincinnati College of Nursing and Health, ML038, Cincinnati, Ohio 45221

Cincinnati Veterans Affairs Medical Center; University of Cincinnati Medical Center

Department of environmental health at the University of Cincinnati College of Medicine

1993 by the American Psychiatric Association

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Objective: Patterns of seclusion and restraint over a one-year period at 82 Veterans Affairs medical centers were examined to determine whether use of these interventions was influenced by hospital characteristics (such as geographic location, per diem cost, patient-staff ratio, and university affiliation), patient diagnoses, or reasons for use. Methods: For comparison, medical centers were grouped into seven geographic regions and into three frequency-of-use groups. Mean use rates and hospital characteristics were examined by rank correlational analysis. Results: Among hospital characteristics, only geographic location was associated with differences in use of seclusion and restraint. Mean rates of use in the Pacific and Mid-Atlantic regions were significantly lower than those in other regions. Total hours of seclusion and restraint at the 20 highest-use centers differed from those at the 20 lowest-use centers by a factor of ten. Patients with schizophrenic disorders were secluded or restrained most frequently. Centers with the highest rates used these interventions most frequently for reasons not associated with violent or potentially violent behaviors. Conclusions: The large geographic variations in use of seclusion and restraint may be a function of different standards of practice or of different state laws.

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