Luccarelli James, Gan Tsu K, Golas Sara B, Sriraman Poorvi, Snydeman Colleen K, Sacks Chana A, McCoy Thomas H
Massachusetts General Hospital, 32 Fruit Street, Yawkey 6A, Boston, MA, 02114, USA.
Harvard Medical School, Boston, MA, USA.
J Gen Intern Med. 2025 May;40(7):1559-1566. doi: 10.1007/s11606-024-09113-x. Epub 2024 Oct 10.
The use of restraints in hospitalized patients is associated with physical and psychological adversity for patients and staff. The minimization of restraint use is a key goal in the hospital setting. Reaching this goal requires an accurate assessment of existing patterns of use across clinical settings.
This study reports the rate of physical restraints among patients hospitalized within a multi-entity healthcare network along with stratification by care context, diagnostic, and demographic factors, and examines the sensitivity and specificity of ICD-10 code Z78.1 "physical restraint status" for defining physical restraints relative to electronic health record (EHR) documentation.
The EHR was used for a retrospective analysis of all adults hospitalized between 2017 and 2022.
Hospitalized adults.
Patient demographics, structured diagnostic information, care area, length of stay, and in-hospital mortality, Z78.1 coding for physical restraints, restraint documentation in orders and flowsheets.
Among 742,607 hospitalizations, 6.3% (n=47,041) involved the use of physical restraint based on coding or EHR documentation. Treatment in the intensive care unit (ICU) included restraint in 39% of encounters whereas treatment outside the ICU included restraint use in 1.3% of encounters. Besides critical illness, demographic factors including increasing age (adjusted odds ratio (aOR)=1.21 [1.19-1.23]), male gender (aOR=1.56, [1.52-1.60]), unknown race (aOR=1.27 [1.19-1.35]), and preferred language other than English (aOR=1.24, [1.18-1.29]) were associated with higher odds of restraint utilization. As compared to EHR orders or documentation of restraint, the ICD-10 code for physical restraint had a sensitivity of 1.5% and a specificity of 99.99%.
Among adults admitted to acute care hospitals, clinical, demographic, and operational factors were associated with increased odds of restraint, with care in the ICU associated with greatly increased odds of restraint. Research into restraint utilization using coded administrative claims data is likely limited by the sensitivity of physical restraint coding.
在住院患者中使用约束措施会给患者和医护人员带来身体和心理上的不良影响。尽量减少约束措施的使用是医院环境中的一个关键目标。要实现这一目标，需要准确评估各临床环境中现有的使用模式。
本研究报告了在一个多实体医疗网络中住院患者的身体约束率，并按护理背景、诊断和人口统计学因素进行分层，同时检验了国际疾病分类第十版（ICD-10）编码Z78.1“身体约束状态”相对于电子健康记录（EHR）文档定义身体约束的敏感性和特异性。
利用电子健康记录对2017年至2022年间所有住院的成年人进行回顾性分析。
住院成年人。
患者人口统计学特征、结构化诊断信息、护理区域、住院时间和院内死亡率、身体约束的ICD-10编码、医嘱和流程表中的约束记录。
在742,607次住院中，6.3%（n = 47,041）的患者基于编码或电子健康记录文档使用了身体约束。重症监护病房（ICU）的治疗中，39%的病例使用了约束措施，而ICU以外的治疗中，1.3%的病例使用了约束措施。除了危重病外，人口统计学因素包括年龄增长（调整后的优势比（aOR）= 1.21 [1.19 - 1.23]）、男性（aOR = 1.56，[1.52 - 1.60]）、种族未知（aOR = 1.27 [1.19 - 1.35]）以及非英语首选语言（aOR = 1.24，[1.18 - 1.29]）与更高的约束使用几率相关。与电子健康记录中的约束医嘱或文档相比，身体约束的ICD-10编码敏感性为1.5%，特异性为99.99%。
在入住急性护理医院的成年人中，临床、人口统计学和操作因素与更高的约束几率相关，在ICU接受护理与显著更高的约束几率相关。使用编码行政索赔数据对约束使用情况进行的研究可能受到身体约束编码敏感性的限制。
