Study Finds Disproportionate Use of Restraints on Black Patients in Emergency Departments

In a recent meta-analysis published in JAMA Internal Medicine, researchers have shed light on an ongoing concern within healthcare settings: the uneven utilization of physical restraints on Black patients in emergency departments. This revelation has raised concerns about the potential harm, both physical and psychological, inflicted on Black patients and the impact on trust in the healthcare system.

The study, which analyzed data from over 2.5 million patient encounters, revealed that Black patients are more frequently subjected to physical restraints compared to their white counterparts and individuals from diverse racial backgrounds. It’s important to note that such incidents occurred in only 0.94% of cases, but the implications are significant.

While researchers acknowledged that there may be justifiable reasons for using physical restraints in certain clinical situations, they expressed concern about their excessive application. 

The stark disproportionality in the use of restraints, as highlighted through an analysis of six peer-reviewed studies involving nearly 1.6 million patient encounters, has the potential to worsen existing health disparities and contribute to the persistence of structural issues within the healthcare system.

One noteworthy aspect of the analysis was the observation that Hispanic ethnicity patients appeared to face a lower risk of physical restraint compared to their non-Hispanic counterparts. However, researchers cautioned against placing undue confidence in this trend due to inconsistent methodologies for classifying race and the categorization of Black patients as non-Hispanic.

It’s important to acknowledge that the study had limitations, primarily stemming from the scarcity and varying quality of the studies included in the analysis. Additionally, it did not delve into the specific factors contributing to this problem, leaving important questions unanswered.

Nevertheless, these findings align with previous investigations conducted in in-patient and pediatric healthcare settings. A recurring theme in these prior studies was the increased likelihood of Black patients encountering a hospital security response. Researchers speculated on potential reasons behind this pattern, citing the possibility of misdiagnosis of psychotic disorders among Black patients and limited access to outpatient behavioral health treatment. The lack of access to outpatient mental healthcare could lead to more advanced illness stages, increasing the likelihood of restraint use—a reflection of systemic racism’s potential role in these situations.

Beyond systemic factors, there is the issue of unconscious biases at an individual level that might inadvertently contribute to differential treatment during psychiatric emergencies when healthcare staff lack structured protocols. To address this deeply ingrained issue, researchers suggested the development of restraint checklists in collaboration with professional groups or organizations, along with the implementation of early verbal de-escalation techniques. However, they acknowledged that the effectiveness of these strategies remains a subject of ongoing debate.