Design and Implementation of an Agitation Code Response Team in the Emergency Department

Wong, Ambrose H.; Ray, Jessica; Cramer, Laura D.; Brashear, Taylor K.; Eixenberger, Christopher; McVaney, Caitlin; Haggan, Jeanie; Sevilla, Mark; Costa, Donald S.; Parwani, Vivek; Ulrich, Andrew; Dziura, James; Bernstein, Steven; Venkatesh, Arjun K.

doi:10.1016/j.annemergmed.2021.10.013

Cited by 17 publications

(19 citation statements)

References 58 publications

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“…An ED nurse determined race in 1 study, 1 asked patients to report their race directly via questionnaire, and 1 study did not report how race was determined. Three of the 10 studies identified Hispanic/Latinx as a race, whereas 5 reported Hispanic/Latinx and not Hispanic/Latinx ethnicity. Two studies categorized race into White or other only .…”

Section: Resultsmentioning

confidence: 99%

“…In all but 1 study, Asian patients had lower point prevalence of restraint use compared with White patients, and all 4 showed lower point prevalence compared with other racial groups. Compared with non-Hispanic ethnic populations, those of Hispanic ethnicity had lower point prevalence of restraint use than non-Hispanic patients …”

Section: Resultsmentioning

confidence: 99%

“…Because of differences in the definition of “other” race, we did not calculate these ratios for the other race category. In 1 study, other included all those not categorized as White or Black, 2 included those who were not categorized as “Asian, Black or African American, or White,” and the remaining 3 had variable definitions of other based on a larger number of named racial categories . We used Stata statistical software (version 17 2021, StataCorp) to complete data analysis.…”

Section: Methodsmentioning

confidence: 99%

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Racial Disparities in Emergency Department Physical Restraint Use

Eswaran,

Molina,

Hwong

et al. 2023

JAMA Intern Med

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ImportanceRecent studies have demonstrated that people of color are more likely to be restrained in emergency department (ED) settings compared with other patients, but many of these studies are based at a single site or health care system, limiting their generalizability.ObjectiveTo synthesize existing literature on risk of physical restraint use in adult EDs, specifically in reference to patients of different racial and ethnic backgrounds.Data SourcesA systematic search of PubMed, Embase, Web of Science, and CINAHL was performed from database inception to February 8, 2022.Study SelectionIncluded peer-reviewed studies met 3 criteria: (1) published in English, (2) original human participants research performed in an adult ED, and (3) reported an outcome of physical restraint use by patient race or ethnicity. Studies were excluded if they were conducted outside of the US, or if full text was unavailable.Data Extraction and SynthesisFour independent reviewers (V.E., M.M., D.D., and A.H.) abstracted data from selected articles following Meta-Analysis of Observational Studies in Epidemiology guidelines. A modified Newcastle-Ottawa scale was used to assess quality. A meta-analysis of restraint outcomes among minoritized racial and ethnic groups was performed using a random-effects model in 2022.Main Outcome(s) and Measure(s)Risk of physical restraint use in adult ED patients by racial and ethnic background.ResultsThe search yielded 1597 articles, of which 10 met inclusion criteria (0.63%). These studies represented 2 557 983 patient encounters and 24 030 events of physical restraint (0.94%). In the meta-analysis, Black patients were more likely to be restrained compared with White patients (RR, 1.31; 95% CI, 1.19-1.43) and to all non-Black patients (RR, 1.27; 95% CI, 1.23-1.31). With respect to ethnicity, Hispanic patients were less likely to be restrained compared with non-Hispanic patients (RR, 0.85; 95% CI, 0.81-0.89).Conclusions and RelevancePhysical restraint was uncommon, occurring in less than 1% of encounters, but adult Black patients experienced a significantly higher risk of physical restraint in ED settings compared with other racial groups. Hispanic patients were less likely to be restrained compared with non-Hispanic patients, though this observation may have occurred if Black patients, with a higher risk of restraint, were included in the non-Hispanic group. Further work, including qualitative studies, to explore and address mechanisms of racism at the interpersonal, institutional, and structural levels are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Racial Disparities in Emergency Department Physical Restraint Use

Eswaran,

Molina,

Hwong

et al. 2023

JAMA Intern Med

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“…By talking, explaining, guiding, and accompanying patients, patients can be calmed, and the physical restraint use can be reduced effectively, which is in line with other studies (Alostaz et al, 2021; Ertuğrul & Özden, 2021). In addition, it is suggested that multidisciplinary collaboration, including shared decision‐making, early removal of unnecessary tubes, and targeted measures to ensure patient comfort (Vincent et al, 2016), can reduce the use of physical restraint (Wong et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Critical care nurses' experiences of physical restraint in intensive care units: A qualitative systematic review and meta‐synthesis

Lao

Chen

Zhang

et al. 2022

Journal of Clinical Nursing

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Introduction Physical restraint is widely used in intensive care units. Critical care nurses are the primary decision makers and practitioners of physical restraint. However, little is known about the qualitative evidence of their experience of physical restraint. Aims To aggregate, synthesise and interpret the qualitative evidence of studies that explored critical care nurses' experiences of physical restraint in intensive care units. Methods A qualitative systematic review and meta‐synthesis was conducted following Joanna Briggs Institute methodology and reported following the ENTREQ statement. Qualitative studies published in the English and Chinese were systematically searched in eight databases. PubMed, Web of Science, CINAHL, EMBASE, PsycINFO, China National Knowledge Infrastructure, Wan Fang, and Chinese Biomedical Literature Database from inception to November 2021. Two reviewers independently assessed the study eligibility and performed the data extraction and the quality appraisal. A meta‐aggregative approach was used to synthesise findings. The review protocol was registered prospectively with PROSPERO (CRD42021278671). Results Thirteen studies were included. A total of 48 intact and definite codes were extracted and classified into ten sub‐categories. Four themes were finally identified: intention, alternatives, determinants, and reflection. Conclusion The intention of critical care nurses to use physical restraint is primarily driven by patient safety. Nurses will consider alternatives; however, many determinants urge nurses to implement physical restraint. Nurses prefer to sacrifice patients' comfort to ensure their safety. When nurses reflect on what they have done, some experience moral distress, but most rationalise their decision making. Further studies should explore the safety of alternatives, reduce the use of physical restraint, and pay more attention to nurses' moral distress through these insights. Relevance to clinical practice Developing alternatives, providing relevant training for nurses, physicians, patients, and families to facilitate a restraint‐free culture, and developing high‐quality guidelines and regulations are essential strategies to reduce the use of physical restraint in ICUs.

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“…Others have extended the code activation concept to other high-risk areas, such as massive pulmonary embolism and patient agitation. 11 , 12 Hospital and ED crowding, intertwined with a nursing staffing crisis has brought new relevance to the value of minimizing time in the ED and rapidly moving patients to the endoscopy suite or ICU. Furthermore, crowding has been shown to delay care for critically ill patients, even those with code team activations.…”

Section: Introductionmentioning

confidence: 99%

A Novel Multidisciplinary Team Activation for Patients with Severe Gastrointestinal Bleeding: Creation of the Code GI Bleed Protocol

Baugh¹,

Sodickson²,

Kivlehan³

et al. 2023

CEG

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Patients with gastrointestinal (GI) bleeding present to the emergency department (ED) with a wide spectrum of illness severity. Among the most critically ill patients, comorbidities and other risk factors, such as liver disease and anticoagulation, can complicate their management. These patients are resource-intensive to stabilize and resuscitate, often requiring the continuous attention of multiple ED staff members along with rapid mobilization of specialty care. At a tertiary care hospital with the ability to provide definitive care for the most critically ill patients with GI bleeding, we introduced a multi-disciplinary team activation pathway to bring together specialists to immediately respond to the ED. We designed a Code GI Bleed pathway to expedite hemodynamic stabilization, diagnostics, source control, and timely disposition out of the ED to the intensive care unit or relevant procedural area of the hospital.

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Design and Implementation of an Agitation Code Response Team in the Emergency Department

Cited by 17 publications

References 58 publications

Racial Disparities in Emergency Department Physical Restraint Use

Racial Disparities in Emergency Department Physical Restraint Use

Critical care nurses' experiences of physical restraint in intensive care units: A qualitative systematic review and meta‐synthesis

A Novel Multidisciplinary Team Activation for Patients with Severe Gastrointestinal Bleeding: Creation of the Code GI Bleed Protocol

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