Seclusion Rates and Workplace Violence on a Psychiatric Emergency Department Unit.
Joshua D Moran Jimenez, Christa Walden, Alexa Carey and 4 others
PMID 40415706WHAT IT FOUND
After adding violence screening, patient-specified agitation factors, de-escalation preferences, handoff communication, staff training, and post-incident debriefs on a psychiatric emergency unit, seclusion hours fell from 5.56 to 3.73 per 1,000 length-of-stay hours, and workplace violence reports fell from four to three.
Key findings
01The average seclusion rate was 5.56 seclusion hours per 1,000 length-of-stay hours before implementation and 3.73 seclusion hours per 1,000 length-of-stay hours after implementation, with November described as an outlier.
02Workplace violence reports in the psychiatric ED fell from four reports before implementation to three reports after implementation.
03Implementation was incomplete: 78.72% of 1,043 patients had a documented VAT score, 10.11% of those scored high risk, and 52.63% of seclusion events had a debriefing form completed.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The project was a single-site before-and-after quality improvement effort with no control group and no statistical test. The pre-intervention period was April to September 2023, while the post-intervention period was October 2023 through February 2024, so the workplace violence report counts cover unequal time spans. Adherence was incomplete: the paper reports 52.63% of seclusion events had a debriefing form completed and 49.64% of admitted patients had the VAT score communicated to the receiving inpatient nurse. Training was not universal: 61.54% of psychiatric ED nurses and 62.74% of psychiatric IP nurses received brief training before implementation. November was an outlier, with three of nine seclusion patients representing 76% of total seclusion time for that month. The violence screening tool needed further testing for reliability and validity. Patient race, culture, and acuity were not measured, so bias and case mix may affect seclusion rates.
Declared interests
The authors declared no potential conflicts of interest and received no financial support.
The easy way to misread this
Do not conclude that the violence screening tool alone reduced seclusion or workplace violence. The project bundled screening, patient-specified agitation factors, de-escalation preferences, handoff communication, staff training, and post-incident debriefs, used a before-and-after design without a control group, and had incomplete adherence, so the contribution of any single component cannot be separated.