Variation in restraint use between hospitals: a multilevel analysis of multicentre prevalence measurements in Switzerland and Austria

Thomann, Silvia; Hahn, Sabine; Bauer, Silvia; Richter, Dirk; Zwakhalen, Sandra (2021). Variation in restraint use between hospitals: a multilevel analysis of multicentre prevalence measurements in Switzerland and Austria BMC Health Services Research, 21, pp. 1-10. BioMed Central

[img]
Preview
Text
Thomann_et_al_2021_ML.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (469kB) | Preview

Background: In restraint use in the somatic acute-care hospital setting, routine and institutional culture seem to play an important role. This implies that similar patient situations would be managed with restraints in one hospital, while in another hospital the situation would be managed without restraints. This practice variation appears to be ethically and legally questionable. The influence of organisation-specific factors such as the availability of guidelines is discussed. However, the relevance of such factors at the hospital level has been rarely investigated to date. Therefore, the aims of this study were a) to determine how much variance in restraint use can be explained on the hospital level (hospital general effect) and b) to examine the impact of organisational factors on restraint use (specific contextual effects). Methods: A secondary data analysis of cross-sectional multicentre data was performed. Data were collected during three quality measurements (2016–2018) in acute-care hospitals in Switzerland and Austria. Hospitalised patients from different medical specialties aged 18+ with informed consent were included. Descriptive analysis and multilevel logistic regression analysis were performed. Results: The study included 29,477 patients from a total of 140 hospitals. The 30-day prevalence rate of patients with at least one restraint was 8.7% (n = 2577). The availability of guidelines regarding restraint use and refresher courses for nursing staff were associated with less restraint use (odds ratios = 0.60 and 0.75). By adding the hospital as a random effect, the explained variance of the model increased from 24 to 55%. Conclusions: The use of restraints varies widely between hospitals, even considering patient characteristics. The identification of situations in which restraints were used out of routine or institutional culture appears to be an important approach in restraint reduction. Investments in appropriate structures and employee knowledge can facilitate providing restraint-free care as much as possible. Keywords: Hospitals, Multilevel analysis, Organisational culture, Quality of health care, Restraint

Item Type:

Journal Article (Original Article)

Division/Institute:

School of Health Professions
School of Health Professions > Nursing
School of Health Professions > Nursing > Field of Innovation - Quality and Quality Development

Name:

Thomann, Silvia0000-0002-9768-4845;
Hahn, Sabine0000-0002-2697-2014;
Bauer, Silvia;
Richter, Dirk0000-0002-6215-6110 and
Zwakhalen, Sandra

ISSN:

1472-6963

Publisher:

BioMed Central

Projects:

[UNSPECIFIED] Prävalenzmessung

Language:

English

Submitter:

Luca Federico

Date Deposited:

19 Jan 2022 11:51

Last Modified:

19 Jan 2022 11:52

Additional Information:

Date: 2021

ARBOR DOI:

10.24451/arbor.16257

URI:

https://arbor.bfh.ch/id/eprint/16257

Actions (login required)

View Item View Item
Provide Feedback