In its latest release of statistics aimed at shedding more light on the quality of the nation’s health care system, the Obama Administration targets the use of physical restraints on psychiatric patients.
It collected data from more than 1,500 facilities nationally. The results show Frisbie Memorial Hospital in Rochester with the fifth highest rate of restraint use in the country.
According to the report, which covers October 2012 through March 2013, Frisbie restrained inpatients on its psychiatric unit at a rate of 88 hours for every 1,000 patient hours. To put that in perspective, the national average is .39 hours.
“This is a patient safety issue, it is a quality issue and it is an issue of valuing and respecting patient autonomy and independence,” says Dr. William Kassler, Chief Medical Officer for the Centers for Medicare and Medicaid Services New England Region.
He says the Obama Administration is releasing this type of data for the first time so that policy makers, patients and their families can make better decisions.
“We hope that these measures provide one indication of the quality of care delivered within inpatient psychiatric facilities,” says Kassler.
Physical restraints are defined as a device or material that immobilizes or restricts a patient’s arms, legs, torso or head.
Methods include everything from a wheelchair lap belt to nylon wrist cuffs used to lash someone to a bed.
“That’s frightening for the patient, it can be demeaning, and so we really try to use as many strategies as possible before we make that determination,” says Dr. Alexander De Nesnera, Associate Medical Director at New Hampshire Hospital.
During the time period covered, Frisbie’s rate of restraint use is 122 times higher than New Hampshire Hospital, a government-run facility that arguably handles the sickest patients in the state.
De Nesnera says there are times where restraints can’t be avoided because patients are so out of control they pose a risk to themselves and others. Restraint, he says, isn’t treatment, and it can be dangerous for people in distress.
His facility has taken steps to lower its reliance on restraints, including limiting how long someone can be restricted to one hour, rather than continuous holds.
It isn’t clear what types of restraints are taking place inside Frisbie’s psychiatric unit. It declined interview requests.
In a statement, the hospital writes the data may be skewed because its facility only treats patients over age 65. Frisbie says for this older population, restraints such as wrap-around bed rails and waist harnesses are relied upon to reduce the risk of falls.
According to data, Frisbie’s rate is still nine times higher than the next hospital in New Hampshire for patients in this age group.
Even these seemingly safe types of restraint pose real risk.
“If you restrain the patient, you are not necessarily cutting down the risk of injury,” says Dover-based geriatric psychiatrist Sandeep Sobti. “And the reason is, if the patient is in a lap belt and they are struggling with that, they can injure themselves. Their skin is frail, you could have a skin tear. If your patient has bed rails up, they could have their arm stuck in there, and you won’t find them until tomorrow morning.”
Sobti says a wide body of academic research confirms restraints actually do little to prevent accidents, and that lowering beds or installing alarms are preferable to putting rails up because a disoriented patient could try to climb over.
Part of CMS’s goal here is to encourage high users to adopt these restraint-free techniques.
“Providing stimulation, providing light, moving people toward the nursing station where they may have more attendance and stimulation and more supervision…all of these things can decrease the kinds of behavioral disturbances that sometimes have been used as reasons people are placed in restraints,” says Dr. Steve Bartels, a psychiatry professor at Dartmouth.
He says some of these initiatives may cost more, but that just spending money alone won’t change a hospital’s outcomes.
“Staffing is a major issue, education is another. Moving toward a culture change around having a restraint-free environment is something that needs to come from leadership at the top,” says Bartels.
CMS cautions this is only the first year of data and some facilities have made reporting mistakes, so patients and their families shouldn’t jump to any conclusions.
Frisbie, for its part, says it will continue reviewing the matter.