Revista Científica de la Sociedad Española de Medicina de Urgencias y Emergencias
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5.5
1er cuartil (4 de 32)
Emergency Medicine
Resumen
Original article
97-102
April
2023
97
102
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Verbal de-escalation to reduce the use of mechanical restraint during nonvoluntary ambulance transfers
Córcoles MartÃnez D, Ramos Perdigues S, González Fresnedo AM, Bellsolà González M, Malagón Amor A, MartÃn López LM
Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain. Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain. Departmento de PsiquiatrÃa y Medicina Forense, Universitat Autonoma de Barcelona, Spain. Departament de Salut, Sistema d’Emergències Mèdiques, L’Hospitalet de Llobregat, Barcelona, Spain. Servei Andorrà d’Atenció Sanità ria, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany Andorra.
Objective. To evaluate the usefulness of annual training in verbal de-escalation techniques for reducing the use of mechanical restraints during nonvoluntary ambulance transfers of patients with mental health problems who need emergency care.
Methods. Quasi-experimental before-after study. Patients with mental diseases treated by a psychiatric team and transferred from home without their consent were included from January through December 2008 in Barcelona. Since 2013, the team had been attending annual training sessions in verbal de-escalation based on the recommendations
of the BETA project (Best Practices in the Evaluation and Treatment of Agitation). We compared the prevalence of the use of mechanical restraint before and after the team started verbal de-escalation training. We also analyzed variables associated with the need to use restraints.
Results. Patients in 633 nonvoluntary transfers were included. Mechanical restraints were used in 42.0% of transfers before de-escalation training and in 20.6% of transfers afterwards, reflecting a 50.1% reduction. Logistic regression identified younger age and the presence of psychotic symptoms as factors associated with the use of restraints; the
use of verbal de-escalation was a protective factor (P < 0.005).
Conclusions. Annual training in verbal de-escalation techniques following the BETA project’s recommendations led to a 50% reduction in the need to use mechanical restraint during nonvoluntary ambulance transfers of patients with mental health problems.
Methods. Quasi-experimental before-after study. Patients with mental diseases treated by a psychiatric team and transferred from home without their consent were included from January through December 2008 in Barcelona. Since 2013, the team had been attending annual training sessions in verbal de-escalation based on the recommendations
of the BETA project (Best Practices in the Evaluation and Treatment of Agitation). We compared the prevalence of the use of mechanical restraint before and after the team started verbal de-escalation training. We also analyzed variables associated with the need to use restraints.
Results. Patients in 633 nonvoluntary transfers were included. Mechanical restraints were used in 42.0% of transfers before de-escalation training and in 20.6% of transfers afterwards, reflecting a 50.1% reduction. Logistic regression identified younger age and the presence of psychotic symptoms as factors associated with the use of restraints; the
use of verbal de-escalation was a protective factor (P < 0.005).
Conclusions. Annual training in verbal de-escalation techniques following the BETA project’s recommendations led to a 50% reduction in the need to use mechanical restraint during nonvoluntary ambulance transfers of patients with mental health problems.
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