Objective The use of seclusion or restraint (S/R) as an emergency medical inter-
vention to assist patients in regaining behavioral control continues to be an area of
interest and concern for the Joint Commission on the Accreditation of Healthcare
Organizations (JCAHO), consistent with the ongoing concerns in the medical,
patient advocate, legislative and legal communities. This study examined unit
characteristics and the use of S/R in a VA facility with a secured, acute mental health
unit before and after the promulgation of the JCAHO 2000 standards for utilization
of S/R for behavioral health reasons.
Methods Variables examined include patient acuity, patient census, number of
admits, number of discharges, length of stay, number of nursing staff on duty, critical
incidents and S/R hours per month.
Results Results indicated S/R use began showing a notable decrease corresponding
to the time that senior unit management began discussions of the new JCAHO
standards. These reductions maintained statistical signiﬁcance even after controlling
for changes in unit environmental variables.
Keywords Seclusion Æ Restraint Æ Inpatient psychiatry
The use of seclusion or restraint (S/R) as an emergency medical intervention to assist
patients in regaining behavioral control continues to be an area of interest and
Previously presented as a poster session at the annual convention of the Association for
Advancement of Behavior Therapy in New Orleans, LA. Meeting dates: November 18–21, 2004
R. Pollard, Ph.D. Æ E. V. Yanasak, Ph.D. (&) Æ S. A. Rogers, Ph.D. Æ A. Tapp, M.D.
VA Puget Sound Health Care System, American Lake Division, Mental Health Service,
(A-116-R), 9600 Veterans Dr. S.W, Tacoma 98493, USA
A. Tapp, M.D.
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
Psychiatr Q (2007) 78:73–81
Organizational and Unit Factors Contributing
to Reduction in the Use of Seclusion and Restraint
Procedures on an Acute Psychiatric Inpatient Unit
Richard Pollard, Ph.D. Æ Elisia V. Yanasak, Ph.D. Æ
Steven A. Rogers, Ph.D. Æ Andre´ Tapp, M.D.
Published online: 11 November 2006
Springer Science+Business Media, LLC 2006