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Likelihood of Ordering Physical Restraints: Influence of Physician Characteristics

Authors

  • Satinderpal K. Sandhu MD,

    1. From the aDepartment of Medicine, Case Western Reserve University School of Medicine, Senior Health Wellness Center, MetroHealth Medical Center, Cleveland, Ohio; bIndependence Foundation Professor of Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee; cDepartment of Medicine, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida; dHope Hospice and Commuity Services, Fort Myers, Florida; eCollege of Nursing, and kLibraries and Media Services Department, Kent State University, Kent, Ohio; fDepartment of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; gDepartment of Surgery, Divisions of hHospital Medicine and iInfectious Diseases, jPalliative Care Services, Division of Geriatrics and Palliative Care, MetroHealth Medical Center, Cleveland, Ohio; and lDepartment of Biostatistics, School of Medicine and School of Nursing, Vanderbilt University, Nashville, Tennessee.
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  • a Lorraine C. Mion PhD, RN,

    1. From the aDepartment of Medicine, Case Western Reserve University School of Medicine, Senior Health Wellness Center, MetroHealth Medical Center, Cleveland, Ohio; bIndependence Foundation Professor of Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee; cDepartment of Medicine, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida; dHope Hospice and Commuity Services, Fort Myers, Florida; eCollege of Nursing, and kLibraries and Media Services Department, Kent State University, Kent, Ohio; fDepartment of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; gDepartment of Surgery, Divisions of hHospital Medicine and iInfectious Diseases, jPalliative Care Services, Division of Geriatrics and Palliative Care, MetroHealth Medical Center, Cleveland, Ohio; and lDepartment of Biostatistics, School of Medicine and School of Nursing, Vanderbilt University, Nashville, Tennessee.
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  • b Rabia Halim Khan DO,

    1. From the aDepartment of Medicine, Case Western Reserve University School of Medicine, Senior Health Wellness Center, MetroHealth Medical Center, Cleveland, Ohio; bIndependence Foundation Professor of Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee; cDepartment of Medicine, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida; dHope Hospice and Commuity Services, Fort Myers, Florida; eCollege of Nursing, and kLibraries and Media Services Department, Kent State University, Kent, Ohio; fDepartment of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; gDepartment of Surgery, Divisions of hHospital Medicine and iInfectious Diseases, jPalliative Care Services, Division of Geriatrics and Palliative Care, MetroHealth Medical Center, Cleveland, Ohio; and lDepartment of Biostatistics, School of Medicine and School of Nursing, Vanderbilt University, Nashville, Tennessee.
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  • cd Ruth Ludwick PhD, RN,

    1. From the aDepartment of Medicine, Case Western Reserve University School of Medicine, Senior Health Wellness Center, MetroHealth Medical Center, Cleveland, Ohio; bIndependence Foundation Professor of Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee; cDepartment of Medicine, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida; dHope Hospice and Commuity Services, Fort Myers, Florida; eCollege of Nursing, and kLibraries and Media Services Department, Kent State University, Kent, Ohio; fDepartment of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; gDepartment of Surgery, Divisions of hHospital Medicine and iInfectious Diseases, jPalliative Care Services, Division of Geriatrics and Palliative Care, MetroHealth Medical Center, Cleveland, Ohio; and lDepartment of Biostatistics, School of Medicine and School of Nursing, Vanderbilt University, Nashville, Tennessee.
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  • e Jeffrey Claridge MD,

    1. From the aDepartment of Medicine, Case Western Reserve University School of Medicine, Senior Health Wellness Center, MetroHealth Medical Center, Cleveland, Ohio; bIndependence Foundation Professor of Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee; cDepartment of Medicine, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida; dHope Hospice and Commuity Services, Fort Myers, Florida; eCollege of Nursing, and kLibraries and Media Services Department, Kent State University, Kent, Ohio; fDepartment of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; gDepartment of Surgery, Divisions of hHospital Medicine and iInfectious Diseases, jPalliative Care Services, Division of Geriatrics and Palliative Care, MetroHealth Medical Center, Cleveland, Ohio; and lDepartment of Biostatistics, School of Medicine and School of Nursing, Vanderbilt University, Nashville, Tennessee.
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  • fg James C. Pile MD,

    1. From the aDepartment of Medicine, Case Western Reserve University School of Medicine, Senior Health Wellness Center, MetroHealth Medical Center, Cleveland, Ohio; bIndependence Foundation Professor of Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee; cDepartment of Medicine, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida; dHope Hospice and Commuity Services, Fort Myers, Florida; eCollege of Nursing, and kLibraries and Media Services Department, Kent State University, Kent, Ohio; fDepartment of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; gDepartment of Surgery, Divisions of hHospital Medicine and iInfectious Diseases, jPalliative Care Services, Division of Geriatrics and Palliative Care, MetroHealth Medical Center, Cleveland, Ohio; and lDepartment of Biostatistics, School of Medicine and School of Nursing, Vanderbilt University, Nashville, Tennessee.
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  • fhi Michael Harrington MD,

    1. From the aDepartment of Medicine, Case Western Reserve University School of Medicine, Senior Health Wellness Center, MetroHealth Medical Center, Cleveland, Ohio; bIndependence Foundation Professor of Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee; cDepartment of Medicine, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida; dHope Hospice and Commuity Services, Fort Myers, Florida; eCollege of Nursing, and kLibraries and Media Services Department, Kent State University, Kent, Ohio; fDepartment of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; gDepartment of Surgery, Divisions of hHospital Medicine and iInfectious Diseases, jPalliative Care Services, Division of Geriatrics and Palliative Care, MetroHealth Medical Center, Cleveland, Ohio; and lDepartment of Biostatistics, School of Medicine and School of Nursing, Vanderbilt University, Nashville, Tennessee.
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  • fj Janice Winchell BS,

    1. From the aDepartment of Medicine, Case Western Reserve University School of Medicine, Senior Health Wellness Center, MetroHealth Medical Center, Cleveland, Ohio; bIndependence Foundation Professor of Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee; cDepartment of Medicine, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida; dHope Hospice and Commuity Services, Fort Myers, Florida; eCollege of Nursing, and kLibraries and Media Services Department, Kent State University, Kent, Ohio; fDepartment of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; gDepartment of Surgery, Divisions of hHospital Medicine and iInfectious Diseases, jPalliative Care Services, Division of Geriatrics and Palliative Care, MetroHealth Medical Center, Cleveland, Ohio; and lDepartment of Biostatistics, School of Medicine and School of Nursing, Vanderbilt University, Nashville, Tennessee.
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  • and k Mary S. Dietrich PhD l

    1. From the aDepartment of Medicine, Case Western Reserve University School of Medicine, Senior Health Wellness Center, MetroHealth Medical Center, Cleveland, Ohio; bIndependence Foundation Professor of Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee; cDepartment of Medicine, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida; dHope Hospice and Commuity Services, Fort Myers, Florida; eCollege of Nursing, and kLibraries and Media Services Department, Kent State University, Kent, Ohio; fDepartment of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; gDepartment of Surgery, Divisions of hHospital Medicine and iInfectious Diseases, jPalliative Care Services, Division of Geriatrics and Palliative Care, MetroHealth Medical Center, Cleveland, Ohio; and lDepartment of Biostatistics, School of Medicine and School of Nursing, Vanderbilt University, Nashville, Tennessee.
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Address correspondence to Satinderpal Sandhu, Senior Health Wellness Center, MetroHealth Old Brooklyn Campus, 4229 Pearl Road, Cleveland, OH 44109. E-mail: ssandhu@metrohealth.org

Abstract

OBJECTIVES: To determine physician knowledge regarding restraint regulations and effectiveness and effect of physician characteristics on likelihood of ordering restraints.

DESIGN: Cross-sectional, factorial research survey.

SETTING: Academic medical center.

PARTICIPANTS: Interns in all specialties; residents in internal medicine, family practice, emergency medicine, psychiatry, and surgery; and attending faculty at an academic medical center.

MEASUREMENTS: Survey of demographic, professional, and restraint knowledge items and for each of five distinct vignettes; physician ratings of probability of patient harm and likelihood of ordering restraints. For each, physicians rated probability of patient harm and likelihood of ordering restraint.

RESULTS: One hundred eighty-nine of 246 (77%) surveys were returned. More than half (58%) were men; the median age was 30 (range 25–63), median years experience was 2 (range 0–33), and 60% were U.S. medical school graduates. Mean knowledge score was 68.4% (range 27–100%). Mean likelihood of ordering restraints ranged from 0.6 (not likely) to 9 (absolutely) (overall mean 3.9 ± 2.2). Exploratory hierarchical regression on mean likelihood of ordering restraint (outcome) with independent variables of physician age and sex (Step 1), years experience and physician level (Step 2), specialization (Step 3), restraint knowledge (Step 4), and judgment of harm (Step 5) explained 31.9% of the variance (F=7.19, degrees of freedom 13,159, P<.001). Higher appraisal of harm (P<.001), less knowledge regarding restraint (P=.03), and male sex (P=.005) were unique indicators for the likelihood of ordering restraints. Psychiatry (P=.03) or internal medicine physicians (P=.05) were less likely to order restraints.

CONCLUSION: Physician characteristics and lack of restraint knowledge are associated with likelihood of ordering restraints. Results will guide medical education initiatives to reduce restraint rates.

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