Disparities in the Use of Chemical and Physical Restraints in the Emergency Department by Race/Ethnicity.

BACKGROUND: Restraints are often utilized in the emergency department (ED) to prevent patients from injuring themselves or others while managing their agitation in order to deliver appropriate medical care. Chemical and physical restraints are ordered at the discretion of the medical provider and typically employed after reasonable verbal de-escalation has been attempted. While health inequities and racial bias in medicine and healthcare have been well-established, information on the differences in the selection and use of restraints by race and ethnicity are scarce. METHODS: This retrospective cohort study utilized national data from HCA Healthcare ED and inpatient database with patient visits from 2016 to 2019 to evaluate the relationships between race and ethnicity and the utilization of restraints in the ED. Associations are reported using linear and logistic regression analyses. RESULTS: The study population included 12,229 unique ED admissions for patients 16 and older with diagnoses of aggression or agitation who had either chemical or physical restraints used. There was no statistically significant difference when comparing Black or other race to White patients and the type of restraint used. Hispanic patients received 0.206 fewer doses of chemical restraints compared to White patients (p = 0.008, 95% C.I. [-0.359, -0.053]) and were slightly less likely to receive physical restraints compared with White patients (p = 0.044, 95% C.I. [0.467, 0.989]), but there was no difference between use of physical restraint and Black or other patients compared to White patients. CONCLUSIONS: In this national sample of agitated and/or aggressive ED patients who were restrained, Hispanic patients were slightly less likely to receive physical restraints and received fewer doses of chemical restraints than White patients. There were no differences between Black or other patients compared to White patients in restraint type, number of doses of chemical restraint or time to application of either restraint type. This suggests that physicians apply the use of chemical restraints to agitated and aggressive ED patients based on factors that are not  associated with race and ethnicity.

Perceptions of Advocacy in High School Students: A Pilot Study.

Assessing perceptions and attitudes of advocacy in adolescent populations is an important area of research. Previous studies have shown that advocacy programs in high schools are well-received and help promote health advocacy. This pilot study took place at the University of Central Florida College of Medicine Health Leaders Summer Academy hosted by medical students of the Student National Medical Association. A one-hour interactive workshop was administered to high school students interested in the healthcare field. Pre- and post-survey data were collected to assess participants' perceptions, methods, and barriers to engaging in advocacy. A total of 29 students were included in this study. Results indicated that students' definitions of advocacy changed after completing the workshop, as a higher percentage of students indicated that they practiced advocacy (pre-survey, 82.76% versus post-survey, 95.45%). There was a statistically significant difference in perceptions of the importance of advocacy in the student's future career (pre-survey, 3.82 versus post-survey, 4.15, p = .035). Social media was the most effective and common form of advocacy used (post-survey 72.73%). The most common barrier to practicing advocacy was a lack of education on a particular topic (31.82% post-survey). Overall, the workshop increased participants' interest in engaging in advocacy. Future directions include expanding the study to a larger population sample throughout the Orlando community and researching the use of social media as a tool for advocacy.