Code De-Escalation: Decreasing restraint use during agitation management in a community hospital emergency department.

INTRODUCTION: Restraint use in the emergency department (ED) can pose significant risks to patients and health care workers. We evaluate the effectiveness of Code De-escalation- a standardized, team-based approach for management and assessment of threatening behaviors- in reducing physical restraint use and workplace violence in a community ED. METHODS: A retrospective observational study of a pathway on physical restraint use among patients placed on an involuntary psychiatric hold in a community ED. This pathway includes a built-in step for the team members to systematically assess perceptions of threats from the patient behavior and threats perceived by the patient. Our primary outcome was the change in the rate of physical restraint use among patients on an involuntary psychiatric hold. Our secondary outcome was the change in the rate of workplace violence events involving all ED encounters. We evaluated our outcomes by comparing all encounters in a ten-month period before and after implementation, and compared our results to rates at neighboring community hospitals within the same hospital network. RESULTS: Pre intervention there were 434 ED encounters involving a psychiatric hold, post-intervention there were 535. We observed a significant decrease in physical restraint use, from 7.4% to 3.7% (ARR 0.028 [95% CI 0.002-0.055], p < 0.05). This was not seen at the control sites. CONCLUSIONS: A standardized de-escalation algorithm can be effective in helping ED's decrease their use of physical restraints in management of psychiatric patients experiencing agitation.

Effects of prior exposure to office noise and music on aspects of working memory.

Previous research has suggested that prior exposure to noise reduces the effect of subsequent exposure due to habituation. Similarly, a number of studies have shown that exposure to Mozart's music leads to better subsequent spatial reasoning performance. Two studies were conducted to extend these findings. The first one examined whether habituation occurs to office noise (including speech) and, if so, how long it takes to develop. Thirty-six young adults participated in the first study which compared effects of office noise with quiet on the performance of a maths task. The study also examined the effects of prior exposure to the office noise on the subsequent effect of the noise. The results showed that performance was initially impaired by the office noise but that the effects of the noise were removed by 10 minutes of exposure between tasks. The second experiment attempted to replicate the "Mozart effect" which represents an improvement in spatial reasoning following listening to Mozart. The study also examined whether the Mozart effect could be explained by changes in mood. Twenty-four young adults participated in the study. The results replicated the Mozart effect and showed that it was not due to changes in mood. Overall, these results show that prior exposure to noise or music can influence aspects of working memory. Such effects need to be incorporated into models of effects of noise on cognition and attempts have to be made to eliminate alternative explanations rather than just describing changes that occur in specific contexts.