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 settingPrivate Equity Among US Psychiatric Hospitals
Shields M, Yang Y, Busch S. Private Equity Among US Psychiatric Hospitals. JAMA Psychiatry 2025, 82: 701-708. PMID: 40397464, PMCID: PMC12096323, DOI: 10.1001/jamapsychiatry.2025.0689.Peer-Reviewed Original ResearchConceptsPsychiatric hospitalHospital staffingMeasures of case mixHealth care qualityNational quality measuresCross-sectional associationsInpatient psychiatric hospitalizationFreestanding psychiatric hospitalCross-sectional studyAverage length of stayRegistered nursesCare qualityStaffing ratiosHealth careLength of stayMain OutcomesPE ownershipPatient vulnerabilityCase-mixPatient daysAdjusted modelsLow staffPrivate equityStaffingHospitalDisparities in use of physical restraint and chemical sedation in the emergency department by patient housing status
Robinson L, Ryus C, Nath B, Kumar A, Desai R, Shah D, Faustino I, Wong A. Disparities in use of physical restraint and chemical sedation in the emergency department by patient housing status. PLOS ONE 2025, 20: e0319286. PMID: 40080507, PMCID: PMC11906057, DOI: 10.1371/journal.pone.0319286.Peer-Reviewed Original ResearchConceptsPatient's housing statusEmergency departmentHousing statusPhysical restraintSedative usePsychiatric emergency careAdverse health outcomesCross-sectional studyLogistic regression modelsRestraint ordersEmergency careHealth outcomesED visitsPatient raceYears of ageDescriptive statisticsHealthcare networkRegional healthcare networkChemical sedationHoused patientsDemographic factorsMarginalized populationsRegression modelsCareChief complaint
2023
Restraint and Seclusion Practices and Policies in U.S. Forensic Psychiatric Hospitals.
Wasser T, Strockbine B, Uyanwune Y, Kapoor R. Restraint and Seclusion Practices and Policies in U.S. Forensic Psychiatric Hospitals. The Journal Of The American Academy Of Psychiatry And The Law 2023, 51: 566-574. PMID: 38065618, DOI: 10.29158/jaapl.230099-23.Peer-Reviewed Original ResearchMeSH KeywordsHospitals, PsychiatricHumansMental DisordersPatient IsolationPsychiatryRestraint, PhysicalSurveys and QuestionnairesUnited StatesConceptsUnited StatesForensic hospital settingInstitutional levelInternational contextRestraint policiesPolicyService directorsForensic psychiatric hospitalNational surveySeclusion practicePracticeSeclusion useMost respondentsRespondentsUse of restraintsStateSurveyContextRestraintHoldSeclusionSignificant effortsPsychiatry settingEffortsPsychiatric hospitalInterrupting Cascades of Physical Restraint as a Path to Health Equity for Hospitalized Children.
Tolliver D, Edwards J, Venkatesh A. Interrupting Cascades of Physical Restraint as a Path to Health Equity for Hospitalized Children. Hospital Pediatrics 2023, 13: e292-e294. PMID: 37691615, DOI: 10.1542/hpeds.2023-007350.Peer-Reviewed Original Research
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 ResearchMeSH KeywordsAggressionEmergency Service, HospitalHumansPatient Outcome AssessmentPsychomotor AgitationQualitative ResearchRestraint, PhysicalConceptsEmergency 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 ResearchMeSH KeywordsForensic PsychiatryHospitals, PsychiatricHumansInpatientsPsychiatryRestraint, PhysicalRisk AssessmentViolenceConceptsForensic 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 ResearchMeSH KeywordsEmergency Service, HospitalHumansInterrupted Time Series AnalysisPsychomotor AgitationQuality ImprovementRestraint, PhysicalConceptsResponse 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 ResearchMeSH KeywordsHospitals, PsychiatricHumansMental DisordersPatient IsolationPublic SectorRestraint, PhysicalViolenceConceptsPsychiatric 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 periodAssociation of Race/Ethnicity and Other Demographic Characteristics With Use of Physical Restraints in the Emergency Department
Wong AH, Whitfill T, Ohuabunwa EC, Ray JM, Dziura JD, Bernstein SL, Taylor RA. Association of Race/Ethnicity and Other Demographic Characteristics With Use of Physical Restraints in the Emergency Department. JAMA Network Open 2021, 4: e2035241. PMID: 33492372, PMCID: PMC7835716, DOI: 10.1001/jamanetworkopen.2020.35241.Peer-Reviewed Original Research
2020
Nationally Advancing Quality Improvement in Restraint and Seclusion Measures
Li L, Mathis WS. Nationally Advancing Quality Improvement in Restraint and Seclusion Measures. Psychiatric Services 2020, 71: 1322-1323. PMID: 33256532, DOI: 10.1176/appi.ps.202000461.Commentaries, Editorials and LettersProcedural, Treatment, and Ethics Considerations of Behavioral Emergencies During Coronavirus Disease 2019 and Relaxed Seclusion Guidelines
Parker CB, Calhoun A, Wasser T, Carvalho V, Dike C. Procedural, Treatment, and Ethics Considerations of Behavioral Emergencies During Coronavirus Disease 2019 and Relaxed Seclusion Guidelines. Journal Of The Academy Of Consultation-Liaison Psychiatry 2020, 62: 155-156. PMID: 33162111, PMCID: PMC7550256, DOI: 10.1016/j.psym.2020.10.005.Peer-Reviewed Original ResearchOne-leg inactivity induces a reduction in mitochondrial oxidative capacity, intramyocellular lipid accumulation and reduced insulin signalling upon lipid infusion: a human study with unilateral limb suspension
Bilet L, Phielix E, van de Weijer T, Gemmink A, Bosma M, Moonen-Kornips E, Jorgensen JA, Schaart G, Zhang D, Meijer K, Hopman M, Hesselink MKC, Ouwens DM, Shulman GI, Schrauwen-Hinderling VB, Schrauwen P. One-leg inactivity induces a reduction in mitochondrial oxidative capacity, intramyocellular lipid accumulation and reduced insulin signalling upon lipid infusion: a human study with unilateral limb suspension. Diabetologia 2020, 63: 1211-1222. PMID: 32185462, PMCID: PMC7228997, DOI: 10.1007/s00125-020-05128-1.Peer-Reviewed Original ResearchMeSH KeywordsHumansInsulinInsulin ResistanceLegLipid MetabolismMaleMitochondriaMuscle, SkeletalOxidative StressRestraint, PhysicalSignal TransductionConceptsMitochondrial oxidative capacityLow mitochondrial oxidative capacityLipid infusionInsulin resistancePhysical inactivityOxidative capacityLipid-induced insulin resistanceUnilateral lower limb suspensionConclusions/interpretationTogetherIntramyocellular lipid depositionMusculus tibialis anteriorChronic metabolic disorderIntramyocellular lipid accumulationType 2 diabetesReduced insulin sensitivityMuscle fat accumulationMusculus vastus lateralisMitochondrial functionUnilateral limb suspensionIMCL contentContralateral legInsulin sensitivityResultsIn vivoTibialis anteriorFat accumulationExperiences 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
Use of sedatives and restraints for treatment of agitation in the emergency department
Wong AH, Crispino L, Parker J, McVaney C, Rosenberg A, Ray JM, Whitfill T, Iennaco JD, Bernstein SL. Use of sedatives and restraints for treatment of agitation in the emergency department. The American Journal Of Emergency Medicine 2018, 37: 1376-1379. PMID: 30598374, DOI: 10.1016/j.ajem.2018.12.027.Peer-Reviewed Original ResearchExecutive Summary
Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, Watson PL, Weinhouse GL, Nunnally ME, Rochwerg B, Balas MC, van den Boogaard M, Bosma KJ, Brummel NE, Chanques G, Denehy L, Drouot X, Fraser GL, Harris JE, Joffe AM, Kho ME, Kress JP, Lanphere JA, McKinley S, Neufeld KJ, Pisani MA, Payen JF, Pun BT, Puntillo KA, Riker RR, Robinson BRH, Shehabi Y, Szumita PM, Winkelman C, Centofanti JE, Price C, Nikayin S, Misak CJ, Flood PD, Kiedrowski K, Alhazzani W. Executive Summary. Critical Care Medicine 2018, 46: 1532-1548. PMID: 30113371, DOI: 10.1097/ccm.0000000000003259.Peer-Reviewed Original ResearchClinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, Watson PL, Weinhouse GL, Nunnally ME, Rochwerg B, Balas MC, van den Boogaard M, Bosma KJ, Brummel NE, Chanques G, Denehy L, Drouot X, Fraser GL, Harris JE, Joffe AM, Kho ME, Kress JP, Lanphere JA, McKinley S, Neufeld KJ, Pisani MA, Payen JF, Pun BT, Puntillo KA, Riker RR, Robinson BRH, Shehabi Y, Szumita PM, Winkelman C, Centofanti JE, Price C, Nikayin S, Misak CJ, Flood PD, Kiedrowski K, Alhazzani W. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Critical Care Medicine 2018, 46: e825-e873. PMID: 30113379, DOI: 10.1097/ccm.0000000000003299.Peer-Reviewed Original ResearchConceptsAgitation/sedationManagement of painClinical practice guidelinesAdult patientsPractice guidelinesPractice statementsCritical illness survivorsTreatment of painBest practice statementsCritical care medicineInternational expertsICU survivorsRecommendations AssessmentIll adultsClinical caveatsGuideline groupSection groupImproved outcomesSleep disruptionCare medicineDeliriumPainClinical relevanceSedationGuideline developmentPhysical 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
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