ArticleBMJ open2022
Qualitative study of patient experiences and care observations during agitation events in the emergency department: implications for systems-based practice.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 18 citations in OpenAlex.
- A Research Agenda for Acute Pediatric Mental and Behavioral Health Emergencies.Annals of emergency medicine · 2026Article
- Workplace violence against nurses is a patient safety crisis, not "part of the job".Health affairs scholar · 2026Article
- Association between patient primary language, physical restraints, and intramuscular sedation in the emergency department.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025Article
- Article
- Predicting Agitation Events in the Emergency Department Through Artificial Intelligence.JAMA network open · 2025Article
- Racial, Ethnic, and Age-Related Disparities in Sedation and Restraint Use for Older Adults in the Emergency Department.The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry · 2025Article
- "I do not know the advantages of having a general practitioner" - a qualitative study exploring the views of low-acuity emergency patients without a regular general practitioner toward primary care.BMC health services research · 2024Article
- Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol.BMJ open · 2024Article
- Racial and Ethnic Disparities in Patient Restraint in Emergency Departments by Police Transport Status.JAMA network open · 2024Article
- A Qualitative Study of Emergency Physicians' and Nurses' Experiences Caring for Patients With Psychiatric Conditions and/or Substance Use Disorders.Annals of emergency medicine · 2023Article
- Curated collections for educators: Nine key articles and article series for teaching qualitative research methods.AEM education and training · 2023Article
Corrections and comments
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Authors and funding
12 authors at 5 institutions in 1 country.
Funding
Abstract
objectivesAgitation, defined as excessive psychomotor activity leading to aggressive or violent behaviour, is prevalent in the emergency department (ED) due to rising behavioural-related visits. Experts recommend use of verbal de-escalation and avoidance of physical restraint to manage agitation. However, bedside applications of these recommendations may be limited by system challenges in emergency care. This qualitative study aims to use a systems-based approach, which considers the larger context and system of healthcare delivery, to identify sociotechnical, structural, and process-related factors leading to agitation events and physical restraint use in the ED.
designQualitative study using a grounded theory approach to triangulate interviews of patients who have been physically restrained with direct observations of agitation events.
settingTwo EDs in the Northeast USA, one at a tertiary care academic centre and the other at a community-based teaching hospital.
participantsWe recruited 25 individuals who experienced physical restraint during an ED visit. In addition, we performed 95 observations of clinical encounters of agitation events on unique patients. Patients represented both behavioural (psychiatric, alcohol/drug use) and non-behavioural (medical, trauma) chief complaints.
resultsThree primary themes with implications for systems-based practice of agitation events in the ED emerged: (1) pathways within health and social systems; (2) interpersonal contexts as reflections of systemic stressors on behavioural emergency care and (3) systems-based and patient-oriented strategies and solutions.
conclusionsAgitation events represented manifestations of patients' structural barriers to care from socioeconomic inequities and high burden of emotional and physical trauma as well as staff members' simultaneous exposure to external stressors from social and healthcare systems. Potential long-term solutions may include care approaches that recognise agitated patients' exposure to psychological trauma, improved coordination within the mental health emergency care network, and optimisation of physical environment conditions and organisational culture.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.