Background: Delirium is a common clinical syndrome, particularly among elderly patients in the inpatient hospital setting, and carries considerable associated morbidity. These patients can display symptoms of inattention, agitation, and restlessness, often necessitating the use of chemical or physical restraints to ensure the safety of the patient and staff. Unfortunately, these interventions are not without the risk of harm. Adverse effects from physical restraints have been shown to increase the incidence of falls, physical injuries, thrombotic events, even rhabdomyolysis and death. Often, chemical restraints in the form of antipsychotics are used to minimize the use of physical restraints, but themselves carry risk of QT prolongation, respiratory depression, extrapyramidal symptoms, and neuroleptic malignant syndrome. Little research has been done into how the COVID-19 pandemic has affected the use of restraints and antipsychotics and what trends continue in our post-pandemic hospital systems.
Methods: A retrospective, cross-sectional analysis of all adult hospital admissions to a large, tertiary care, academic hospital of the outcomes of receipt of delirium, mechanical restraint order or receipt of an antipsychotic from August 1, 2018 to January 1, 2024. Delirium was defined as any positive bCAM during the admission.
Results: 133,906 admissions were included in this study. Of these admissions, 8.1% received an order for mechanical restraints while 39.8% had a documented delivery of an antipsychotic medication. The proportion of patient’s receiving an antipsychotic medication per month was increased linearly, from 25.3% to over 50%. Restraint and delirium rates increased only modestly over this time period from 8.1 to approximately 10% and from 12.5 to approximately 20%, respectively.
Conclusions: The startling increase in antipsychotic use during inpatient hospital admissions was an unexpected finding in this data analysis. Further analysis into factors contributing to this increase in antipsychotic delivery is ongoing, including diagnosis associated with admissions, primary services, and demographic data. Early analysis suggests no significant link between demographic factors and this increase in mechanical and chemical restraint use. Factors such as staffing, patient acuity, proportion of ICU patients included, and service team are all being investigated as potential influential factors.