2025
Peer support enhanced behavioural crisis response teams in the emergency department: protocol for a stepped-wedge cluster-randomised controlled trial
Nath B, Desai R, Cook J, Dziura J, Davis-Plourde K, Youins R, Guy K, Pavlo A, Smith E, Smith D, Kangas K, Heckmann R, Hart L, Powsner S, Sevilla M, Evans M, Kumar A, Faustino I, Hu Y, Bellamy C, Wong A. Peer support enhanced behavioural crisis response teams in the emergency department: protocol for a stepped-wedge cluster-randomised controlled trial. BMJ Open 2025, 15: e103775. PMID: 40484432, PMCID: PMC12161358, DOI: 10.1136/bmjopen-2025-103775.Peer-Reviewed Original ResearchConceptsCluster randomised controlled trialEmergency departmentPeer supportDelivery of trauma-informed careStepped-wedge cluster randomised controlled trialExperience of mental illnessPhysical restraintRate of physical restraintBehavioral crisesPeer support workersReduce restraint useSecondary outcomesFollow-up data collectionResponse teamPatient-centred approachPositive patient outcomesTrauma-informed carePeer-reviewed journalsCrisis response teamsUsual careStepped-wedgeIntervention readinessPeer deliveryRestraint useED settingCharacterizing Emergency Department Care for Patients With Histories of Incarceration
Huang T, Socrates V, Ovchinnikova P, Faustino I, Kumar A, Safranek C, Chi L, Wang E, Puglisi L, Wong A, Wang K, Taylor R. Characterizing Emergency Department Care for Patients With Histories of Incarceration. Journal Of The American College Of Emergency Physicians Open 2025, 6: 100022. PMID: 40012663, PMCID: PMC11852703, DOI: 10.1016/j.acepjo.2024.100022.Peer-Reviewed Original ResearchCare processesHistory of incarcerationRestraint useEmergency departmentHealth care team membersMeasuring care processesCompare socio-demographic characteristicsCare team membersHealth care disparitiesEmergency department careHealth care systemSocio-demographic characteristicsUnique patient encountersMultivariate logistic regressionCare disparitiesHealth behaviorsED settingCare systemPatient encountersSubstance use historyMedical adviceLogistic regressionDemographic characteristicsTeam membersCare
2024
Racial, Ethnic, and Age-Related Disparities in Sedation and Restraint Use for Older Adults in the Emergency Department
Jivalagian P, Gettel C, Smith C, Robinson L, Brinker M, Shah D, Kumar A, Faustino I, Nath B, Chang-Sing E, Taylor R, Kennedy M, Hwang U, Wong A. Racial, Ethnic, and Age-Related Disparities in Sedation and Restraint Use for Older Adults in the Emergency Department. American Journal Of Geriatric Psychiatry 2024, 33: 1-14. PMID: 39054237, PMCID: PMC11625012, DOI: 10.1016/j.jagp.2024.07.004.Peer-Reviewed Original ResearchPhysical restraint useRestraint useOlder adultsED visitsPhysical restraintEmergency departmentElectronic health record dataHealth record dataBlack non-HispanicPatient-level characteristicsAge-related disparitiesAssociated with increased useRegional hospital networkCross-sectional studyLogistic regression modelsChemical sedationRetrospective cross-sectional studyNon-Hispanic groupNon-HispanicAgitation managementHospital sitesHospital networkRecord dataWhite non-Hispanic groupPrimary outcomeFormative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol
Wong A, Nath B, Shah D, Kumar A, Brinker M, Faustino I, Boyce M, Dziura J, Heckmann R, Yonkers K, Bernstein S, Adapa K, Taylor R, Ovchinnikova P, McCall T, Melnick E. Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol. BMJ Open 2024, 14: e082834. PMID: 38373857, PMCID: PMC10882402, DOI: 10.1136/bmjopen-2023-082834.Peer-Reviewed Original ResearchConceptsComputerised clinical decision supportED treatRestraint useExperiences of restraint useMental health-related visitsEmergency departmentPrevent agitationSystems-related factorsImprove patient experienceClinical decision support systemsRegional health systemClinical decision supportDe-escalation techniquesRandomised controlled trialsFormative evaluationPeer-reviewed journalsBest-practice guidanceAt-risk populationsCDS toolsThematic saturationED cliniciansPatient experienceED sitesHealth systemED physiciansBuckle me up! A randomised controlled trial using a tablet-based emergency department intervention for child car safety education
Zhang A, Leviter J, Baird J, Charles-Chauvet D, Frackiewicz L, Duffy S, Dessie A. Buckle me up! A randomised controlled trial using a tablet-based emergency department intervention for child car safety education. Injury Prevention 2024, 30: ip-2023-044998. PMID: 38302281, DOI: 10.1136/ip-2023-044998.Peer-Reviewed Original ResearchPaediatric emergency departmentRandomised controlled trialsBehavioral changesEmergency department interventionsChild car restraintsTablet-based toolMotor vehicle crashesFollow-up surveyPositive behavior changePatients aged 0Programme acceptabilityRisk of deathIntervention groupRestraint useEducational interventionCar restraintsEmergency departmentVehicle crashesChildren rideImproper restraintLogistic regressionControlled trialsPositive attitudesKnowledge retentionFollow-up data
2022
Qualitative study of patient experiences and care observations during agitation events in the emergency department: implications for systems-based practice
Wong AH, Ray JM, Eixenberger C, Crispino LJ, Parker JB, Rosenberg A, Robinson L, McVaney C, Iennaco JD, Bernstein SL, Yonkers KA, Pavlo AJ. Qualitative study of patient experiences and care observations during agitation events in the emergency department: implications for systems-based practice. BMJ Open 2022, 12: e059876. PMID: 35545394, PMCID: PMC9096567, DOI: 10.1136/bmjopen-2021-059876.Peer-Reviewed Original ResearchConceptsEmergency departmentAgitation eventsQualitative studyEmergency careQualitative studies of patients' experiencesPhysical restraintStudies of patients' experiencesAvoidance of physical restraintSystem of healthcare deliveryPhysical restraint useEmergency care networkCommunity-based teaching hospitalSystems-based practiceTertiary care academic centreInterviews of patientsVerbal de-escalationGrounded theory approachPatient-oriented strategiesExposure to psychological traumaExcessive psychomotor activityCare approachSocioeconomic inequalitiesPatient experienceRestraint useCare networkAn Analysis of Risk-Assessment Driven Security Restraint Use during the Transport of Forensic Patients.
Wasser TD, Strockbine BA, Hauser LL, Mathew MA, Gay B, Smith HE, Dike CC. An Analysis of Risk-Assessment Driven Security Restraint Use during the Transport of Forensic Patients. The Journal Of The American Academy Of Psychiatry And The Law 2022, 50: 74-83. PMID: 35042737, DOI: 10.29158/jaapl.210050-21.Peer-Reviewed Original ResearchConceptsForensic hospitalState forensic hospitalForensic hospital patientsForensic psychiatric patientsRisk assessment toolHospital patientsRestraint useHigh riskPsychiatric patientsHospital staffPatientsPatient advocatesPatient transportationSignificant riskForensic patientsHospital administratorsTool correlateHospitalRisk
2021
Racial and Ethnic Disparities in Physical Restraint Use for Pediatric Patients in the Emergency Department
Nash KA, Tolliver DG, Taylor RA, Calhoun AJ, Auerbach MA, Venkatesh AK, Wong AH. Racial and Ethnic Disparities in Physical Restraint Use for Pediatric Patients in the Emergency Department. JAMA Pediatrics 2021, 175: 1283-1285. PMID: 34515764, PMCID: PMC8438617, DOI: 10.1001/jamapediatrics.2021.3348.Peer-Reviewed Original ResearchDesign and Implementation of an Agitation Code Response Team in the Emergency Department
Wong AH, Ray JM, Cramer LD, Brashear TK, Eixenberger C, McVaney C, Haggan J, Sevilla M, Costa DS, Parwani V, Ulrich A, Dziura JD, Bernstein SL, Venkatesh AK. Design and Implementation of an Agitation Code Response Team in the Emergency Department. Annals Of Emergency Medicine 2021, 79: 453-464. PMID: 34863528, PMCID: PMC9038629, DOI: 10.1016/j.annemergmed.2021.10.013.Peer-Reviewed Original ResearchConceptsResponse team interventionPhysical restraint useInterrupted time series analysisRestraint useEmergency departmentTeam interventionRates of physical restraint useTeam-based interventionAdministrative supportQuality improvement studyResponse teamBehavioral health systemManagement of agitated patientsInterprofessional collaborationRestraint ordersExcessive psychomotor activityRestraint ratesHealth systemED visitsImprovement studyPhysical restraintCompare trendsPrimary outcomeTime series analysisAgitated patientsImplementing a Program to Reduce Restraint and Seclusion Utilization in a Public-Sector Hospital: Clinical Innovations, Preliminary Findings, and Lessons Learned
Dike CC, Lamb-Pagone J, Howe D, Beavers P, Bugella BA, Hillbrand M. Implementing a Program to Reduce Restraint and Seclusion Utilization in a Public-Sector Hospital: Clinical Innovations, Preliminary Findings, and Lessons Learned. Psychological Services 2021, 18: 663-670. PMID: 32940500, DOI: 10.1037/ser0000502.Peer-Reviewed Original ResearchConceptsPsychiatric hospitalState Mental Health Program DirectorsTertiary care settingPublic sector psychiatric hospitalWellness Recovery Action PlanMental health settingsQuality of careTrauma-sensitive carePublic sector hospitalsEvidence-based practicePositive behavioral support plansStaff injuriesCare settingsRestraint useMedical costsRestraint hoursHealth settingsRecovery Action PlanSensory modulationCase reviewSeclusion useHospitalPrevention toolRestraint ordersBaseline periodDevelopment of a concise injury severity prediction model for pediatric patients involved in a motor vehicle collision
Hartka TR, McMurry T, Weaver A, Vaca FE. Development of a concise injury severity prediction model for pediatric patients involved in a motor vehicle collision. Traffic Injury Prevention 2021, 22: s74-s81. PMID: 34672889, PMCID: PMC8792360, DOI: 10.1080/15389588.2021.1975275.Peer-Reviewed Original ResearchConceptsInjury Severity ScorePediatric patientsTrauma triageSevere injuriesMultivariable logistic modelMotor vehicle collisionsEmergency medical services (EMS) providersPrehospital trauma triageOutcomes of interestLogistic regression modelsReceiver operator curve areaTrauma centerSeverity scoreMedical service providersRestraint usePatient injuryPatientsHighest AUCInjuryInjury listSignificant decreaseCurve areaSignificant differencesVehicle collisionsAirbag deployment
2020
Study protocol for the ACT response pilot intervention: development, implementation and evaluation of a systems-based Agitation Code Team (ACT) in the emergency department
Wong AH, Ray JM, Auerbach MA, Venkatesh AK, McVaney C, Burness D, Chmura C, Saxa T, Sevilla M, Flood CT, Patel A, Whitfill T, Dziura JD, Yonkers KA, Ulrich A, Bernstein SL. Study protocol for the ACT response pilot intervention: development, implementation and evaluation of a systems-based Agitation Code Team (ACT) in the emergency department. BMJ Open 2020, 10: e036982. PMID: 32606062, PMCID: PMC7328814, DOI: 10.1136/bmjopen-2020-036982.Peer-Reviewed Original ResearchConceptsEmergency departmentRestraint useCode teamControlled interrupted time series designResponse interventionsRate of restraint useInterrupted time series designAcute care settingDe-escalation techniquesTime series designPeer-reviewed publicationsED staffIdentified teamworkPilot interventionCare settingsHealth systemPatient encountersAgitation managementHuman Investigation CommitteeWorkplace violenceEthical approvalStaff safetyPatient agitationReduce harmSeries design4123 Characterization of Physical Restraint and Sedative Use for Treatment of Agitation in the Emergency Department
Wong A, Crispino L, Parker J, McVaney C, Rosenberg A, Ray J, Whitfill T, Iennaco J, Bernstein S. 4123 Characterization of Physical Restraint and Sedative Use for Treatment of Agitation in the Emergency Department. Journal Of Clinical And Translational Science 2020, 4: 125-125. PMCID: PMC8823616, DOI: 10.1017/cts.2020.374.Peer-Reviewed Original ResearchLogistic regression modelsRestraint useSedative useEmergency departmentOvert Aggression Scale scoresPhysical restraintOvert Aggression ScaleAggression scale scoresTreatment of agitationAgitated Behavior ScaleSeverity ScaleHigher oddsAgitation ScaleScale scoreLogistic regression models of factorsAssociated with significantly higher oddsTertiary care referral centerUrban tertiary care referral centerProspective cohort study of adult patientsFrequent chief complaintProspective cohort studySignificantly higher oddsAlcohol/drug useCohort study of adult patientsSeverity Scale scoreExperiences of Individuals Who Were Physically Restrained in the Emergency Department
Wong AH, Ray JM, Rosenberg A, Crispino L, Parker J, McVaney C, Iennaco JD, Bernstein SL, Pavlo AJ. Experiences of Individuals Who Were Physically Restrained in the Emergency Department. JAMA Network Open 2020, 3: e1919381. PMID: 31977058, PMCID: PMC6991263, DOI: 10.1001/jamanetworkopen.2019.19381.Peer-Reviewed Original ResearchConceptsEmergency departmentPhysical restraintED visitsExperiences of restraint useQualitative studyExperiences of physical restraintCombination of mental illnessPatient-centered approachMacArthur Perceived Coercion ScaleRestraint experienceParticipants' demographic informationAssociated with injuryExperiences of individualsData saturationEpisodes of physical restraintRestraint ordersCare provisionSelf-reported responsesRestraint useEpisodes of agitationMental illnessLast restraintMain OutcomesEligible visitsPrimary themes
2019
Characteristics and Severity of Agitation Associated With Use of Sedatives and Restraints in the Emergency Department
Wong AH, Crispino L, Parker JB, McVaney C, Rosenberg A, Ray JM, Whitfill T, Iennaco JD, Bernstein SL. Characteristics and Severity of Agitation Associated With Use of Sedatives and Restraints in the Emergency Department. Journal Of Emergency Medicine 2019, 57: 611-619. PMID: 31594740, DOI: 10.1016/j.jemermed.2019.07.019.Peer-Reviewed Original ResearchConceptsAgitated patientsOvert Aggression Scale scoresUse of sedativesRestraint useEmergency departmentOvert Aggression ScaleAggression scale scoresAgitated Behavior ScaleAgitation ScaleScale scoreSedative useHigher oddsAggression ScaleBehavior ScaleBehavioral techniquesTriage chief complaintTertiary referral centerProspective observational studyAgitation severityAlcohol/drug useSeverity Scale scoreLevel of agitationLogistic regression modelsSeverity ScaleDetection of agitation
2018
6.38 Relationship Between Reduction of PRN Psychotropic Medication Use and Seclusion and Restraint Use in a State Psychiatric Hospital for Youth
Nikolov R, Shi H, Smiles J, Gregory F. 6.38 Relationship Between Reduction of PRN Psychotropic Medication Use and Seclusion and Restraint Use in a State Psychiatric Hospital for Youth. Journal Of The American Academy Of Child & Adolescent Psychiatry 2018, 57: s260-s261. DOI: 10.1016/j.jaac.2018.09.399.Peer-Reviewed Original ResearchPhysical Restraint Use in Adult Patients Presenting to a General Emergency Department
Wong AH, Taylor RA, Ray JM, Bernstein SL. Physical Restraint Use in Adult Patients Presenting to a General Emergency Department. Annals Of Emergency Medicine 2018, 73: 183-192. PMID: 30119940, DOI: 10.1016/j.annemergmed.2018.06.020.Peer-Reviewed Original ResearchConceptsPhysical restraint useEmergency departmentRestraint ordersRestraint usePhysical restraintDrug useRegional health systemManagement of behavioral disordersAdult emergency departmentPrevent self-harmCross-sectional studyPrevalence of agitationCross-sectional study of adult patientsAssociation of alcoholAdult patientsGeneral EDHealth systemED visitsManaging agitationMedical complaintsStudy of adult patientsVulnerable populationsSelf-harmUnique patientsTotal ED visits
2013
The impact of state level graduated driver licensing programs on rates of passenger restraint use and unlicensed driving in fatal crashes.
Fu J, Anderson CL, Dziura JD, Crowley MJ, Vaca FE. The impact of state level graduated driver licensing programs on rates of passenger restraint use and unlicensed driving in fatal crashes. AAAM Annual Conference 2013, 57: 89-98. PMID: 24406949, PMCID: PMC3861822.Peer-Reviewed Original ResearchPassenger restraint useRestraint useDriver licensing programsFatality Analysis Reporting SystemNational Highway Traffic Safety Administration's Fatality Analysis Reporting SystemSafety restraint useMultivariate logistic regressionGDL programsFatal crashesGDL lawHigh-risk behaviorsChi-square testUnlicensed drivingLogistic regressionOverall riskLicensing programsMultivariate modelReporting systemRiskPassenger riskSafety behaviorYoung driversYears 1996
2012
Practices, attitudes and perceptions toward road safety in yerevan, republic of armenia.
Chekijian SA, Truzyan N. Practices, attitudes and perceptions toward road safety in yerevan, republic of armenia. AAAM Annual Conference 2012, 56: 191-200. PMID: 23169129, PMCID: PMC3503422.Peer-Reviewed Original ResearchYoung unlicensed drivers and passenger safety restraint use in u.s. Fatal crashes: concern for risk spillover effect?
Fu J, Anderson CL, Dziura JD, Crowley MJ, Vaca FE. Young unlicensed drivers and passenger safety restraint use in u.s. Fatal crashes: concern for risk spillover effect? AAAM Annual Conference 2012, 56: 37-43. PMID: 23169115, PMCID: PMC3503417.Peer-Reviewed Original ResearchConceptsSafety restraint useRestraint usePassenger restraint useYoung unlicensed driversDriver restraint useHigh-risk behaviorsFatal crashesFatality Analysis Reporting SystemDecreased oddsUnlicensed drivingUnlicensed driversLogistic regressionDetrimental roleSafety restraintsDriver drinkingReporting systemCrash fatalitiesImpaired drivingYearsSafety behaviorYears 1996
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