Impact of Clinician Education on Emergency Department Mechanical Restraint: An Interrupted Time-Series Study

Objective

Examine the impact of an education-based intervention co-designed with clinicians on attitudes towards and skills in caring for people with behaviours of concern in an emergency department (ED).

Methods

This 20-month interrupted time-series study (and nested 8-month before-and-after study) was conducted at a metropolitan hospital ED in Melbourne, Australia. The primary outcome was episodes of mechanical restraint before (1 January 2023 to 31 January 2023) and after (1 March 2024 to 30 September 2024) exposure of staff to an educational intervention. Secondary outcomes were staff injuries caused by patients, rate of offering voluntary medication for agitation, and medication timing before (1 October 2023 to 31 January 2024) and after (1 March 2024 to 30 June 2024) the intervention.

Results

Episodes of mechanical restraint were lower after the intervention (mean [SD] before: 5.5 [3.4] episodes per week; mean [SD] after: 2.5 [1.6] episodes per week; mean difference [95% CI]: 3.0 [1.7, 4.4] episodes per week, p < 0.001). There was a change in the level (β [95% CI] episodes per week: 2.22 [−4.35, −0.09], p = 0.041), but not a pre-existing downward trend (−0.00 [−0.07, 0.06], p = 0.960), of mechanical restraint. Staff sustained injuries caused by patients were lower after the intervention (φ = 0.138, p = 0.032). No significant difference was observed for offers of voluntary medication (φ = 0.049, p = 0.717) nor time to medication (mean difference [95% CI]: 67.08 [−83.87, 218.03] minutes, p = 0.374).

Conclusions

A multifaceted educational intervention was associated with fewer episodes of emergency department mechanical restraint and fewer staff injuries caused by patients. Further work is needed to determine generalisability.