The Commonwealth of Massachusetts

Executive Office of Health and Human Services
Department of Public Health
Division of Health Care Quality
99 Chauncy Street, 2nd Floor, Boston, MA 02111
617-753-8000

DEVAL L. PATRICK
GOVERNOR
TIMOTHY P. MURRAY
LIEUTENANT GOVERNOR
JUDYANN BIGBY, MD
SECRETARY
JOHN  AUERBACH
COMMISSIONER	

						Circular Letter:  DHCQ 08-09-499

TO:         Acute Care Hospital Chief Executive Officers

FROM:   Paul I. Dreyer, Director

RE:          Feasibility of Collecting Data on Restraint Use

DATE:     September 24, 2008

As you may be aware, the Departments of Public Health and Mental Health (DPH and DMH) are currently working with provider representatives and advocates for people with behavioral health problems on a number of issues of mutual concern.  One of the issues under discussion is the frequency with which patients in emergency departments are placed in restraints for behavioral reasons. The absence of data about restraint use in hospital emergency departments makes it impossible to know whether concerns about restraint usage reflect isolated events or systemic issues, and, if the latter, what steps might be taken to address those problems. 

The purpose of this letter is to determine whether it is feasible for hospitals to report data on restraints with little or no additional effort. 

In order to make this determination, we are requesting all acute care hospitals to provide one month’s worth of data on the use of restraints in their emergency departments for the month of March 2008. If the hospital keeps restraint data in greater time increments, such as quarterly, that would be acceptable as well. It is important to note that we are not collecting this information for the purpose of analysis or comparison, but rather to determine whether a standardized reporting format can be devised that requires little or no effort for hospital response. 

We are not asking hospitals to generate any reports that do not already exist. Rather we seek restraint data in whatever form your hospital keeps it for purposes of quality improvement and to comply with requests from certification and accreditation entities such as CMS and the Joint Commission, e.g. logs kept for purposes of identifying charts for review by the Joint Commission or DPH. 

Of course, any protected health information should be removed. We also would appreciate contact information for an individual in your institution who can answer questions concerning data collection about restraint usage in the hospital.

If you desire, you may provide further information about your hospital, such as the total number of patients seen in the emergency department during March 2008, the total number of behavioral health patients, your restraint policy, and whether you have a separate emergency psychiatric service at your hospital. If you do not currently keep either QA restraint data or restraint logs in a format which would readily permit segregation of information regarding restraints in the Emergency Department, please note this in your response. 

While we would appreciate any additional data to provide context, the Department is formally requesting only the data routinely kept on restraints in the ED setting for the month of March 2008.

Please send this information by email, if possible, to Lisa.Gurland@state.ma.us, or in hard copy to Lisa Gurland, Department of Public Health, 250 Washington St., Boston MA, 02107, by October 26, 2008. You may call Dr. Gurland with any questions at 617 624 5294. 

If you do not wish to participate in this survey, please notify Dr. Gurland of this fact. 

We appreciate very much your response to this effort. Thank you for your cooperation.