AEM Early Access 43: Disparities in Care: The Role of Race on the Utilization of Physical Restraints in the Emergency Setting

Welcome to the forty-third episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to a recent AEM Article or Article in Press, with an author interview podcast and suggested supportive educational materials for EM learners.

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DISCUSSING (OPEN ACCESS THROUGH oct 31,2020; CLICK ON TITLE TO ACCESS)

Article: Disparities in Care: The Role of Race on the Utilization of Physical Restraints in the Emergency Setting. Kristina Schnitzer MD, Flannery Merideth MD, Wendy Macias‐Konstantopoulos MD, MPH, Douglas Hayden PhD, Derri Shtasel MD, Suzanne Bird MD

LISTEN NOW: INTERVIEW WITH authors dr. kristina schnitzer and DR. Flannery Merideth

Dr. Kristina Schnitzer

Psychiatrist, Schizophrenia Clinical and Research Program, Massachusetts General Hospital

Instructor, Harvard Medical School

Dr. Flannery Merideth

Dr. Merideth is a staff psychiatrist on the Psychiatric Consultation Service at Baystate Medical Center. She completed consultation-liaison psychiatry fellowship at Massachusetts General Hospital and residency at MGH/McLean, where she served as chief resident of the MGH Acute Psychiatry Service. Her interests include medical education, neuropsychiatry, and care of underserved communities.

ABSTRACT:

Objective

Race‐based bias in health care occurs at organizational, structural, and clinical levels and impacts emergency medical care. Limited literature exists on the role of race on patient restraint in the emergency setting. This study sought to examine the role of race in physical restraint in an emergency department (ED) at a major academic medical center.

Methods

Retrospective chart analysis was performed, querying all adult ED visits over a 2‐year period (2016–2018) at Massachusetts General Hospital. The associations between race and restraint and selected covariates (sex, insurance, age, diagnosis, homelessness, violence) were analyzed.

Results

Of the 195,092 unique ED visits by 120,469 individuals over the selected period, 2,658 (1.4%) involved application of a physical restraint by health care providers. There was a significant effect of race on restraint (p < 0.0001). The risk ratio (RR) for Asian patients compared to white patients was 0.71 (95% confidence interval [CI] = 0.55 to 0.92, p = 0.009). The RR for Black patients compared to white patients was 1.22 (95% CI = 1.05 to 1.40, p = 0.007). Visits with patients having characteristics of male sex, public or no insurance, younger age, diagnoses pertaining to substance use, diagnoses pertaining to psychotic or bipolar disorders, current homelessness, and a history of violence were more likely to result in physical restraint.

Conclusions

There was a significant effect of race on restraint that remained when controlling for sex, insurance, age, diagnosis, homelessness, and history of violence, all of which additionally conferred independent effects on risk. These results warrant a careful examination of current practices and potential biases in utilization of restraint in emergency settings.