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Updated April 24, 2013 1
Seclusion and RestraintSix Month Data Report
January – June 2012
Inpatient Psychiatric Service ProvidersPresentation to OHA 4/25/13
Updated April 24, 2013 2
Reporting in statute
• OAC 5122-14-14• All Inpatient Hospital Providers• 6 month reporting:
▫ January – June▫ July – December
• Required Reporting:▫ Seclusion▫ Mechanical Restraint▫ Physical Restraint (aka Manual)▫ By age group (under 18, over 18)▫ S/R related Injury to Staff
Updated April 24, 2013 3
Inpatient Psychiatric Service Providers
•76 hospitals operating during this 6-month period (3 units reported as 1)▫68 serving adults▫16 serving children and adolescents▫ (8 hospitals served both children/adolescents and
adults)
Updated April 24, 2013 4
Calculations allowing comparison across organizations
Seclusion/Restraints per 1000 Patient Day =
Total # of Seclusions/Restraints x1000
Total # of Patient Days
Avg. Duration per Seclusion/Restraint =
Total mins of Seclusion/Restraint
Total # of Seclusions/Restraints
5
Geographical Regions
Updated April 24, 2013
5
Athens Region
Lawrence
Meigs
Gallia
Washington
Monroe
SciotoAdams
Brown
Hamilton
Butler WarrenClinton
Highland
Jackson
RossVinton Athens
PrebleGreene
Fayette
MadisonClark
Miami
Darke Champaign
Franklin
PickawayFairfield
Hocking
Mercer Auglaize
ShelbyLogan
Union
HardinAllen
Van Wert
PauldingPutnam
Hancock
Wyandot
Marion
Delaware
Morrow
Seneca
Sandusky
Ottawa
LucasFultonWilliams
Henry WoodDefiance Erie
Huron
Lorain
Wayne
Medina
Cuyahoga
Summit
Knox
Holmes
Licking
Coshocton
Muskingum
Tuscarawas
Guernsey
PerryMorgan
Noble
Belmont
Harrison
Carroll
ColumbianaStark
Portage
Mahoning
Trumbull
Ashtabula
Geauga
Lake
Crawford
Heartland
Twin Valley
Appalachia
Northcoast
Region
Lawrence
GalliaScioto
Adams
Hamilton
Pike
Jackson
Vinton Athens
Madison
MiamiDarke
Fairfield
Hocking
Mercer Auglaize
Shelby Union
HardinAllen
PutnamHancock
Wyandot
Marion
Delaware
Seneca
Sandusky
Ottawa
Lucas
Wood Erie
Huron
Holmes
Guernsey
Perry MorganNoble
Belmont
Harrison
Clermont
Jefferson
RichlandCrawford Ashland
Montgomery
Heartland
Twin Valley/ Central
Appalachia/ Southeast
Northcoast
Summit,/ Southwest
Northwest
Updated April 24, 2013 6
Inpatient Providers ServingAdults
Updated April 24, 2013 7
Number of Hospitals Serving Adults by Geographical Area (N = 68)
Northeast; 18
Heartland; 8
Southeast; 7Southwest; 13
Central Ohio; 8
Northwest; 14
Updated April 24, 2013 8
Total number of patient days per month
Jan Feb Mar Apr May Jun0
1000
2000
3000
4000
5000
60005403
50045344 5188 5399 5255
635 590 633 605 626 627
OhioMHAS Private
Updated April 24, 2013 9
Capacity (Number of Licensed Beds)
Small (< 20 beds);
27
Medium (20-39 beds); 25
Large (40+
beds); 16
•Min = 6•Mean = 31•sd = 21.7•Max = 96
Updated April 24, 2013 10
Occupancy
• Min = 0.73%• Mean = 63.4%• sd = 20.5%• Max = 102.1%
• Formula:▫ Patient Days divided by▫ Number of Licensed
Beds * 182 (# of days Jan – Jun)
< 50%; 17
50-75%; 28
75+%; 23
Updated April 24, 2013 11
Occupancy by Capacity
Small (< 20 beds)
Medium (20-39 beds)
Large(40+ beds)
0%
20%
40%
60%
80%
100%
52.932.1 39.1
29.4
46.4 30.4
17.6 21.4 30.475%+
50-75%
< 50%
Updated April 24, 2013 12
Average Daily Census• Formula:
▫ Total # of Patient Days divided by
▫ 182 days
• OhioMHAS (N = 6) mean = 173.6
• Private Hospitals (N = 68)
• Mean = 20.5• Min = 0.1• Max = 66.5
0-10 per day; 22
11-19 per day; 23
20+ per day; 23
Private Hospitals
Updated April 24, 2013 13
Percentage of Inpatient Providers Reporting Seclusions and Restraints (N=68)
Seclusions Physical Restraints
Mechanical Restraints
0%
25%
50%
75%
100%
38.2 64.7 33.8
61.8
35.3
66.2 Did Report
Did not report
Updated April 24, 2013 14
Definition of SeclusionStaff intervention that involved the involuntary confinement of a patient alone in a room where the patient is physically prevented from leaving
Updated April 24, 2013 15
Frequency of Seclusions (per 1000 Patient days) 6-month Avg.
0
2
4
6
0.8
4.73.4 2.9
Updated April 24, 2013 16
Frequency of Seclusion (per 1000 Patient days) 6-month Avg. by Geographic Area (N=68)
Northeast Heartland Southeast Southwest Central Northwest0
2
4
6
8
5.6
1.7
0.3
3.6
1.81.4
17Updated April 24, 2013
Frequency of Seclusion (per 1000 Patient days) 6-month Avg. (N=68)Capacity Average Daily Census
Small
(<20
beds
)
Med
ium (2
0-39 b
eds)
Larg
e (40
+ beds
)0
2
4
6
8
0.9
3.0
5.9
Census 0-10
Census 11-19
Census 20+
0
2
4
6
0.7
3.3
4.6
Updated April 24, 2013 18
Frequencies of Seclusions (per 1000 Patient Days)
Jan Feb Mar Apr May Jun0
1
2
3
4
Private Total (N = 68)
OhioMHAS (N = 6)
Updated April 24, 2013 19
Duration of Seclusion (Minutes) 6-month Avg. by Geographical Area
OhioM
HAS
Priva
te To
tal
North
east
Heartl
and
Sout
heas
t
Sout
hwes
t
Centra
l
North
west
0
200
400
600
72
328371 390
330 294236
296
20Updated April 24, 2013
Duration of Seclusion (Minutes) 6-month Avg.Capacity Average Daily Census
Small
(<20
beds
)
Med
ium (2
0-39 b
eds)
Larg
e (40
+ beds
)0
200
400
600
163
463
189
Census 0-10
Census 11-19
Census 20+
0
200
400
600507
400
222
Updated April 24, 2013 21
Duration of Seclusions (Minutes)
Jan Feb Mar Apr May Jun0
250
500
750
1000
Private Total
OhioMHAS
Because average duration was calculated by the number of Seclusions divided by the Number of minutes, the N varies
Updated April 24, 2013 22
Definition of Physical Restraint
restricting a patient’s freedom of movement, physical activity, or normal use of his or her body without the use of Mechanical Restraint devices.
Also known as Manual Restraint, means a staff intervention that involved any method of physically/manually
Updated April 24, 2013 23
Frequency of Physical Restraint (per 1000 Patient days) 6-month Avg.
0
1
2
3 2.31.9
0.8 0.7
Updated April 24, 2013 24
Frequency of Physical Restraints (per 1000 Patient days) 6-month Avg. by Geographical Area (N = 68)
Northeast Heartland Southeast Southwest Central Northwest0
1
2
0.7
0.3 0.3
1.11.3
0.2
25Updated April 24, 2013
Frequency of Physical Restraints (per 1000 Patient days) 6-month Avg.(N = 68)Capacity Average Daily Census
Small
(<20
beds
)
Med
ium (2
0-39 b
eds)
Larg
e (40
+ beds
)0
1
2
0.5 0.61.1
Census 0-10
Census 11-19
Census 20+
0
1
0.2
0.90.8
Updated April 24, 2013 26
Frequencies of Physical Restraints (per 1000 Patient Days)
Jan Feb Mar Apr May Jun0.0
1.0
2.0
3.0
4.0
Private Total (N = 68)
OhioMHAS (N = 6)
Small-size hospitals did not report enough data to graph by month.
Updated April 24, 2013 27
Duration of Physical Restraints (Minutes) 6-month Avg. by Geographical Area
OhioM
HAS
Priva
te To
tal
North
east
Heartl
and
Sout
heas
t
Sout
hwes
t
Centra
l
North
west
0
100
200
300
400
500
267 57
14
483
7 15 42
28Updated April 24, 2013
Duration of Physical Restraints (Minutes) 6-month Avg. Capacity Average Daily Census
Small
(<20
beds
)
Med
ium (2
0-39 b
eds)
Larg
e (40
+ beds
)0
100
200
300
188
6 27
Census 0-10
Census 11-19
Census 20+
0
100
200
300
196
4423
Updated April 24, 2013 29
Durations of Physical Restraints (Minutes)
Jan Feb Mar Apr May Jun0
40
80
120
Private Total
OhioMHAS
Because average duration was calculated by the number of Restraints divided by the Number of minutes, the N varies
Updated April 24, 2013 30
Definition of Mechanical RestraintA staff intervention that involves any method of restricting a patient’s freedom of movement, physical activity, or normal use of his or her body, using an appliance or device manufactured for this purpose.
Updated April 24, 2013 31
Frequency of Mechanical Restraint (per 1000 Patient days) 6-month Avg.
0.0
2.0
4.0
6.0
2.3
5.54.3 3.6
Updated April 24, 2013 32
Frequency of Mechanical Restraints (per 1000 Patient days) 6-month Avg. by Geographical Area (N=68)
Northeast Heartland Southeast Southwest Central Northwest0.0
5.0
10.0
15.0
3.3
1.7 1.5
11.0
0.6 1.0
33Updated April 24, 2013
Frequency of Mechanical Restraints (per 1000 Patient days) 6-month Avg. (N=68)Capacity Average Daily Census
Small
(<20
beds
)
Med
ium (2
0-39 b
eds)
Larg
e (40
+ beds
)0
5
10
0.63.4
9.1
Census 0-10
Census 11-19
Census 20+
0
5
10
0.82.4
7.6
Updated April 24, 2013 34
Frequencies of Mechanical Restraints (per 1000 Patient Days)
Jan Feb Mar Apr May Jun0.0
1.0
2.0
3.0
4.0
5.0
Private Total (N = 68)
OhioMHAS (N = 6)
Small-size hospitals did not report enough data to graph by month.
Updated April 24, 2013 35
Duration of Mechanical Restraints (Minutes) 6-month Avg. by Geographical Area
OhioM
HAS
Priva
te To
tal
North
east
Heartl
and
Sout
heas
t
Sout
hwes
t
Centra
l
North
west
0
200
400
600
86
421542
481
331
436
187
288
36Updated April 24, 2013
Duration of Mechanical Restraints (Minutes) 6-month Avg. Capacity Average Daily Census
Small
(<20
beds
)
Med
ium (2
0-39 b
eds)
Larg
e (40
+ beds
)0
200
400
600
317
457 460
Census 0-10
Census 11-19
Census 20+
0
200
400
600
374 378486
Updated April 24, 2013 37
Durations of Mechanical Restraints (Minutes)
Jan Feb Mar Apr May Jun0
100
200
300
400
500
600
Private Total
OhioMHAS
Because average duration was calculated by the number of Restraints divided by the Number of minutes, the N varies by month
Updated April 24, 2013 38
Inpatient Providers Serving
Children and Adolescents
Updated April 24, 2013 39
Number of Hospitals Serving Children/Youth by Geographical Area
Northeast; 5
Heartland; 2
Southeast; 1
Southwest; 3
Central Ohio; 2
Northwest; 3
Insufficient size within subgroups to run comparisons
Updated April 24, 2013 40
Total number of patient days per month
Jan Feb Mar Apr May Jun0
100
200
300
400
500
600
447 464508
439 467
314
Updated April 24, 2013 41
Capacity
•Minimum = 8 beds•Mean = 24.31
beds•Maximum = 85
beds
•Groups not used for analysis due to small samples size
< 20 beds
20-50 beds
51-90 beds
0
2
4
6
8
10
12
10
5
1
Updated April 24, 2013 42
• Minimum = 2.68%• Mean = 54.02%• sd = 19.4%• Maximum = 78.7%
• Formula:▫ Patient Days divided by▫ Number of Licensed
Beds * 182 (# of days Jan – Jun)
• Groups not used for analysis due to small samples size
Occupancy
< 25% 25-60% 61-80%0
2
4
6
8
10
1
9
6
Updated April 24, 2013 43
• Formula:▫Total # of Patient Days divided by▫182 days
• Minimum = 0.21• Mean = 14.5%• sd = 15.5%• Maximum = 61.31%
• No groups created due to small samples size
Average Daily Census
Updated April 24, 2013 44
Percentage of Inpatient Providers Reporting Seclusions and Restraints (N=16)
Seclusions Physical Restraints
Mechanical Restraints
0%
25%
50%
75%
100%
25%38% 31%
75%63% 69% Did Report
Did not report
45Updated April 24, 2013
Seclusion and RestraintAverage Number (per 1000 Patient Days) Average Duration (Minutes)
Seclu
sions
Phys
ical R
estra
ints
Mec
hanic
al Res
traint
s05
1015 13.5 13.1
3.0
10.1 8.2
2.1
Reported S/R (N = 10-12)All Hospitals (N = 16)
Seclu
sions
Phys
ical R
estra
ints
Mec
hanic
al Res
traint
s0
255075
10047.5
7.1
85.4
Updated April 24, 2013 46
Frequencies of Seclusions and Restraints (per 1000 Patient Days) for All Hospitals (N = 16)
Jan Feb Mar Apr May Jun0
2
4
6
8
10
12
14
Seclusions
Physical Restraints
Mechan-ical Re-straints
Updated April 24, 2013 47
Duration of Seclusions and Restraints (Minutes) (N varies based on number of S/R reported each month)
Jan Feb Mar Apr May Jun0
20
40
60
80
100
120
Mechan-ical Re-straints
Seclusions
Physical Restraints
Updated April 24, 2013 48
All Inpatient Providers
Illnesses and Injuries
49Updated April 24, 2013
Patient Injury or Illness
Injuries requiring emergency/unplanned medical treatment or hospitalization
Illness/medical emergency requiring immediate admission to a hospital
• 25 hospitals reported injuries
• Minimum = 1• Mean = 4.2• sd = 7.0• Maximum = 32
• 53 hospitals reported injuries
• Minimum = 1• Mean = 7.9• sd = 8.1• Maximum = 43
50Updated April 24, 2013
Injuries to Staff from Seclusions and Restraints
Injuries requiring First AidInjuries requiring emergency/ unplanned medical intervention
• 17 hospitals reported injuries
• Minimum = 1• Mean = 5.4• sd = 8.9• Maximum = 39
• 13 hospitals reported injuries
• Minimum = 1• Mean = 1.9• sd = 1.6• Maximum = 7
There were NO injuries requiring hospitalization.
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