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Article: Effect of physical restraint reduction on older patients' hospital length of stay

TitleEffect of physical restraint reduction on older patients' hospital length of stay
Authors
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
Citation
Journal Of The American Medical Directors Association, 2012, v. 13 n. 7, p. 645-650 How to Cite?
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.
Persistent Identifierhttp://hdl.handle.net/10722/160696
ISSN
2014 Impact Factor: 4.939
2014 SCImago Journal Rankings: 1.263
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorKwok, Ten_US
dc.contributor.authorBai, Xen_US
dc.contributor.authorChui, MYPen_US
dc.contributor.authorLai, CKYen_US
dc.contributor.authorHo, DWHen_US
dc.contributor.authorHo, FKYen_US
dc.contributor.authorWoo, Jen_US
dc.date.accessioned2012-08-16T06:16:56Z-
dc.date.available2012-08-16T06:16:56Z-
dc.date.issued2012en_US
dc.identifier.citationJournal Of The American Medical Directors Association, 2012, v. 13 n. 7, p. 645-650en_US
dc.identifier.issn1525-8610en_US
dc.identifier.urihttp://hdl.handle.net/10722/160696-
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.languageengen_US
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jmdaen_US
dc.relation.ispartofJournal Of The American Medical Directors Associationen_US
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 stayen_US
dc.typeArticleen_US
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1525-8610&volume=online first&spage=not known yet&epage=&date=2012&atitle=Effect+Of+Physical+Restraint+Reduction+On+Older+Patients’+Hospital+Length+Stayen_US
dc.identifier.emailKwok, T: tkwok@cuhk.edu.hken_US
dc.identifier.emailBai, X: xuebai@hku.hk-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.jamda.2012.05.019-
dc.identifier.pmid22763142-
dc.identifier.scopuseid_2-s2.0-84865567734-
dc.identifier.hkuros204190en_US
dc.identifier.volume13en_US
dc.identifier.issue7-
dc.identifier.spage645en_US
dc.identifier.epage650en_US
dc.identifier.isiWOS:000308526400014-
dc.publisher.placeUnited States-

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