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Article: Effect of physical restraint reduction on older patients' hospital length of stay
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TitleEffect of physical restraint reduction on older patients' hospital length of stay
 
AuthorsKwok, T4
Bai, X1 4
Chui, MYP3
Lai, CKY2
Ho, DWH4
Ho, FKY4
Woo, J4
 
KeywordsAged hospital patient
Barthel index
Cognitive defect
Confusion
Correlation analysis
 
Issue Date2012
 
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jmda
 
CitationJournal Of The American Medical Directors Association, 2012, v. 13 n. 7, p. 645-650 [How to Cite?]
DOI: http://dx.doi.org/10.1016/j.jamda.2012.05.019
 
AbstractOBJECTIVES: Physical restraints are often used to prevent falls and to secure medical devices in older people in hospitals. Restraint reduction has been advocated on the grounds that physical restraints have negative psychological effects and are not effective in preventing falls. The potential effect of restraint reduction on length of hospital stay (LOS) has not been investigated. This study was undertaken to compare the average length of stay of older patients in a convalescent medical ward setting before and after a restraint reduction program. DESIGN: This is a retrospective study. SETTING: A convalescent hospital in Hong Kong. PARTICIPANTS: This study included 2000 patient episodes. MEASUREMENTS: The use of physical restraint, LOS, and clinical outcomes of randomly selected patient episodes in the year before and after the implementation of a restraint reduction program were compared. The clinical outcomes included Modified Functional Ambulatory Categories and modified Barthel index. Subgroup analysis was performed on those with confusion as defined by dementia diagnosis, low abbreviated mental test score, or abnormal mental domain of Norton Score. RESULTS: A total of 958 and 988 patient episodes admitted to 10 medical wards in a convalescent hospital in 2007 and 2009 were examined. There were no significant differences in the baseline characteristics of patients in the 2 years. With the implementation of the restraint reduction scheme, the rate of physical restraint use declined significantly from 13.3% in 2007 to 4.1% in 2009 for all patients. The average LOS of patients was significantly lower in the year after the implementation of restraint reduction (19.5 +/- 20.7 versus 16.8 +/- 13.4 days in 2007 and 2009 respectively, P < .001). On subgroup analysis, the reduction in LOS was significant in the cognitively impaired patients (23.0 +/- 26.5 to 17.8 +/- 15.0 days in 2007 and 2009 respectively, P < .001), but not in the cognitively normal patients. There were no significant differences between the 2 years in the incidence of fall, mobility, and activities of daily living on discharge. CONCLUSION: Physical restraint reduction was associated with significant reduction in average length of stay in convalescent medical wards, especially in the cognitively impaired patients.
 
ISSN1525-8610
2013 Impact Factor: 4.781
2013 SCImago Journal Rankings: 1.229
 
DOIhttp://dx.doi.org/10.1016/j.jamda.2012.05.019
 
DC FieldValue
dc.contributor.authorKwok, T
 
dc.contributor.authorBai, X
 
dc.contributor.authorChui, MYP
 
dc.contributor.authorLai, CKY
 
dc.contributor.authorHo, DWH
 
dc.contributor.authorHo, FKY
 
dc.contributor.authorWoo, J
 
dc.date.accessioned2012-08-16T06:16:56Z
 
dc.date.available2012-08-16T06:16:56Z
 
dc.date.issued2012
 
dc.description.abstractOBJECTIVES: Physical restraints are often used to prevent falls and to secure medical devices in older people in hospitals. Restraint reduction has been advocated on the grounds that physical restraints have negative psychological effects and are not effective in preventing falls. The potential effect of restraint reduction on length of hospital stay (LOS) has not been investigated. This study was undertaken to compare the average length of stay of older patients in a convalescent medical ward setting before and after a restraint reduction program. DESIGN: This is a retrospective study. SETTING: A convalescent hospital in Hong Kong. PARTICIPANTS: This study included 2000 patient episodes. MEASUREMENTS: The use of physical restraint, LOS, and clinical outcomes of randomly selected patient episodes in the year before and after the implementation of a restraint reduction program were compared. The clinical outcomes included Modified Functional Ambulatory Categories and modified Barthel index. Subgroup analysis was performed on those with confusion as defined by dementia diagnosis, low abbreviated mental test score, or abnormal mental domain of Norton Score. RESULTS: A total of 958 and 988 patient episodes admitted to 10 medical wards in a convalescent hospital in 2007 and 2009 were examined. There were no significant differences in the baseline characteristics of patients in the 2 years. With the implementation of the restraint reduction scheme, the rate of physical restraint use declined significantly from 13.3% in 2007 to 4.1% in 2009 for all patients. The average LOS of patients was significantly lower in the year after the implementation of restraint reduction (19.5 +/- 20.7 versus 16.8 +/- 13.4 days in 2007 and 2009 respectively, P < .001). On subgroup analysis, the reduction in LOS was significant in the cognitively impaired patients (23.0 +/- 26.5 to 17.8 +/- 15.0 days in 2007 and 2009 respectively, P < .001), but not in the cognitively normal patients. There were no significant differences between the 2 years in the incidence of fall, mobility, and activities of daily living on discharge. CONCLUSION: Physical restraint reduction was associated with significant reduction in average length of stay in convalescent medical wards, especially in the cognitively impaired patients.
 
dc.description.natureLink_to_subscribed_fulltext
 
dc.identifier.citationJournal Of The American Medical Directors Association, 2012, v. 13 n. 7, p. 645-650 [How to Cite?]
DOI: http://dx.doi.org/10.1016/j.jamda.2012.05.019
 
dc.identifier.doihttp://dx.doi.org/10.1016/j.jamda.2012.05.019
 
dc.identifier.epage650
 
dc.identifier.hkuros204190
 
dc.identifier.issn1525-8610
2013 Impact Factor: 4.781
2013 SCImago Journal Rankings: 1.229
 
dc.identifier.issue7
 
dc.identifier.openurl
 
dc.identifier.pmid22763142
 
dc.identifier.scopuseid_2-s2.0-84865567734
 
dc.identifier.spage645
 
dc.identifier.urihttp://hdl.handle.net/10722/160696
 
dc.identifier.volume13
 
dc.languageeng
 
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jmda
 
dc.publisher.placeUnited States
 
dc.relation.ispartofJournal Of The American Medical Directors Association
 
dc.subjectAged hospital patient
 
dc.subjectBarthel index
 
dc.subjectCognitive defect
 
dc.subjectConfusion
 
dc.subjectCorrelation analysis
 
dc.titleEffect of physical restraint reduction on older patients' hospital length of stay
 
dc.typeArticle
 
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<item><contributor.author>Kwok, T</contributor.author>
<contributor.author>Bai, X</contributor.author>
<contributor.author>Chui, MYP</contributor.author>
<contributor.author>Lai, CKY</contributor.author>
<contributor.author>Ho, DWH</contributor.author>
<contributor.author>Ho, FKY</contributor.author>
<contributor.author>Woo, J</contributor.author>
<date.accessioned>2012-08-16T06:16:56Z</date.accessioned>
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<identifier.issn>1525-8610</identifier.issn>
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<description.abstract>OBJECTIVES: Physical restraints are often used to prevent falls and to secure medical devices in older people in hospitals. Restraint reduction has been advocated on the grounds that physical restraints have negative psychological effects and are not effective in preventing falls. The potential effect of restraint reduction on length of hospital stay (LOS) has not been investigated. This study was undertaken to compare the average length of stay of older patients in a convalescent medical ward setting before and after a restraint reduction program. DESIGN: This is a retrospective study. SETTING: A convalescent hospital in Hong Kong. PARTICIPANTS: This study included 2000 patient episodes. MEASUREMENTS: The use of physical restraint, LOS, and clinical outcomes of randomly selected patient episodes in the year before and after the implementation of a restraint reduction program were compared. The clinical outcomes included Modified Functional Ambulatory Categories and modified Barthel index. Subgroup analysis was performed on those with confusion as defined by dementia diagnosis, low abbreviated mental test score, or abnormal mental domain of Norton Score. RESULTS: A total of 958 and 988 patient episodes admitted to 10 medical wards in a convalescent hospital in 2007 and 2009 were examined. There were no significant differences in the baseline characteristics of patients in the 2 years. With the implementation of the restraint reduction scheme, the rate of physical restraint use declined significantly from 13.3% in 2007 to 4.1% in 2009 for all patients. The average LOS of patients was significantly lower in the year after the implementation of restraint reduction (19.5 +/- 20.7 versus 16.8 +/- 13.4 days in 2007 and 2009 respectively, P &lt; .001). On subgroup analysis, the reduction in LOS was significant in the cognitively impaired patients (23.0 +/- 26.5 to 17.8 +/- 15.0 days in 2007 and 2009 respectively, P &lt; .001), but not in the cognitively normal patients. There were no significant differences between the 2 years in the incidence of fall, mobility, and activities of daily living on discharge. CONCLUSION: Physical restraint reduction was associated with significant reduction in average length of stay in convalescent medical wards, especially in the cognitively impaired patients.</description.abstract>
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<subject>Aged hospital patient</subject>
<subject>Barthel index</subject>
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<subject>Confusion</subject>
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Author Affiliations
  1. The University of Hong Kong
  2. Hong Kong Polytechnic University
  3. Shatin Hospital
  4. Chinese University of Hong Kong