{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:01:10Z","timestamp":1791201670127,"version":"4.2.0"},"reference-count":30,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"\n BACKGROUND AND OBJECTIVES<\/jats:title>\n Restraints are used in emergency departments to treat acute agitation and prevent harm but can cause injury. Local data demonstrated racial and ethnic disparities in restraint use. Of non-Hispanic Black and Hispanic patients, 2.7% were physically restrained, compared with 1.1% of non-Hispanic White patients. Intramuscular chemical restraint rates were highest among non-Hispanic Black patients at 6.0%, compared with 3.7% in Hispanic patients and 2.6% in non-Hispanic White patients. We sought to reduce these differences to less than 1% within 12\u00a0months.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n We identified drivers to managing agitation, including improved staffing, standardized care protocols, enhanced deescalation training, and early assessment. A multidisciplinary team implemented interventions through Plan-Do-Study-Act cycles, including a standardized pathway, 24\/7 access to behavioral health counselors, care plans, deescalation training, and education on racial disparities. Statistical process control charts were used to track restraint use. Process measures included staff knowledge of racial disparities in restraint use. The balancing measure included the frequency of staff injuries.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Physical restraint rates remained unchanged for non-Hispanic Black and non-Hispanic white but decreased to 1.3% for Hispanic patients. We observed reductions in intramuscular restraint disparities: rates decreased to 1.4% for non-Hispanic Black and 1.2% for Hispanic patients, with 8 consecutive points below the centerline, whereas rates for non-Hispanic white patients remained at 2.6%. Staff injuries did not increase.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n Targeted quality improvement interventions led to reduction in disparities in restraint use. Ongoing work includes simulation-based training and addressing structural drivers.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2025-073158","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:02:31Z","timestamp":1788998551000},"source":"Crossref","is-referenced-by-count":0,"title":["Reducing Inequities in Restraint Use in the Pediatric Emergency Department"],"prefix":"10.1542","volume":"158","author":[{"given":"Motunrayo R.","family":"Adu","sequence":"first","affiliation":[{"name":"1Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut"},{"name":"2Department of Pediatrics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Rolison","sequence":"additional","affiliation":[{"name":"3Child Study Center, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Powers","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut"},{"name":"4Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut"},{"name":"5Department of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandria","family":"Georgadarellis","sequence":"additional","affiliation":[{"name":"6Division of Emergency Medicine, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Kandil","sequence":"additional","affiliation":[{"name":"7Department of Pediatric Critical Care Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Hoffman","sequence":"additional","affiliation":[{"name":"3Child Study Center, Yale School of Medicine, New Haven, Connecticut"},{"name":"8Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Vetter","sequence":"additional","affiliation":[{"name":"4Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Bartone","sequence":"additional","affiliation":[{"name":"4Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Campbell","sequence":"additional","affiliation":[{"name":"4Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Matz","sequence":"additional","affiliation":[{"name":"4Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Grise","sequence":"additional","affiliation":[{"name":"4Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Siew","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut"},{"name":"4Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunjan","family":"Tiyyagura","sequence":"additional","affiliation":[{"name":"1Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut"},{"name":"4Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"issue":"1","key":"2026100507370579900_r1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1097\/01.pec.0000195758.12447.69","article-title":"Restraint use for psychiatric patients in the pediatric emergency department","volume":"22","author":"Dorfman","year":"2006","journal-title":"Pediatr Emerg Care."},{"issue":"1","key":"2026100507370579900_r2","doi-asserted-by":"crossref","first-page":"100277","DOI":"10.1016\/j.acepjo.2025.100277","article-title":"Structural and Clinical Factors Associated with Physical Restraint Use in a Pediatric Emergency Department","volume":"7","author":"Rolison","year":"2025","journal-title":"J Am Coll Emerg Physicians Open."},{"issue":"12","key":"2026100507370579900_r3","doi-asserted-by":"crossref","first-page":"e836","DOI":"10.1097\/PEC.0000000000002385","article-title":"Agitation and Restraint in a Pediatric Psychiatric Emergency Program: Clinical Characteristics and Diagnostic Correlates","volume":"37","author":"Agraharkar","year":"2021","journal-title":"Pediatr Emerg Care."},{"issue":"12","key":"2026100507370579900_r4","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1016\/j.chiabu.2006.02.015","article-title":"Learning from tragedy: a survey of child and adolescent restraint fatalities","volume":"30","author":"Nunno","year":"2006","journal-title":"Child Abuse Negl."},{"key":"2026100507370579900_r5","doi-asserted-by":"crossref","first-page":"491","DOI":"10.3389\/fpsyt.2019.00491","article-title":"Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review","volume":"10","author":"Chieze","year":"2019","journal-title":"Front Psychiatry."},{"issue":"2","key":"2026100507370579900_r6","doi-asserted-by":"crossref","first-page":"4S","DOI":"10.1097\/00004583-200202001-00002","article-title":"Practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions, with special reference to seclusion and restraint","volume":"41","author":"Masters","year":"2002","journal-title":"J Am Acad Child Adolesc Psychiatry."},{"issue":"1","key":"2026100507370579900_r7","doi-asserted-by":"crossref","first-page":"e2022059586","DOI":"10.1542\/peds.2022-059586","article-title":"Standardizing and Improving Care for Pediatric Agitation Management in the Emergency Department","volume":"152","author":"Hoffmann","year":"2023","journal-title":"Pediatrics."},{"issue":"3","key":"2026100507370579900_r8","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1097\/PEC.0000000000003526","article-title":"Don\u2019t Get MAD: Managing Agitation With De-Escalation Training in a Pediatric Emergency Department","volume":"42","author":"Georgadarellis","year":"2026","journal-title":"Pediatr Emerg Care."},{"issue":"5","key":"2026100507370579900_r9","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.annemergmed.2021.10.013","article-title":"Design and Implementation of an Agitation Code Response Team in the Emergency Department","volume":"79","author":"Wong","year":"2022","journal-title":"Ann Emerg Med."},{"issue":"1","key":"2026100507370579900_r10","first-page":"80","article-title":"Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry","volume":"21","author":"Gerson","year":"2023","journal-title":"Focus Am Psychiatr Publ."},{"issue":"12","key":"2026100507370579900_r11","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1001\/jamapediatrics.2021.3348","article-title":"Racial and Ethnic Disparities in Physical Restraint Use for Pediatric Patients in the Emergency Department","volume":"175","author":"Nash","year":"2021","journal-title":"JAMA Pediatr."},{"issue":"6","key":"2026100507370579900_r12","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1136\/qhc.12.6.458","article-title":"Statistical process control as a tool for research and healthcare improvement","volume":"12","author":"Benneyan","year":"2003","journal-title":"Qual Saf Health Care."},{"issue":"5","key":"2026100507370579900_r13","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.jemermed.2014.12.019","article-title":"Statistical process control: separating signal from noise in emergency department operations","volume":"48","author":"Pimentel","year":"2015","journal-title":"J Emerg Med."},{"key":"2026100507370579900_r14","author":"IBM SPSS Statistics for Macintosh","year":"2022"},{"issue":"6","key":"2026100507370579900_r15","doi-asserted-by":"crossref","first-page":"413","DOI":"10.3109\/01612840903484113","article-title":"A review of interventions to reduce mechanical restraint and seclusion among adult psychiatric inpatients","volume":"31","author":"Stewart","year":"2010","journal-title":"Issues Ment Health Nurs."},{"issue":"1","key":"2026100507370579900_r16","first-page":"2","article-title":"Understanding Health Risks for Adolescents in Protective Custody","volume":"9","author":"Beal","year":"2018","journal-title":"J Appl Res Child."},{"key":"2026100507370579900_r17","doi-asserted-by":"crossref","first-page":"105447","DOI":"10.1016\/j.chiabu.2021.105447","article-title":"The accrual of parent reported adverse childhood experiences following a child protective services investigation: A prospective approach","volume":"124","author":"Helton","year":"2022","journal-title":"Child Abuse Negl."},{"issue":"4","key":"2026100507370579900_r18","doi-asserted-by":"crossref","first-page":"e2022058227","DOI":"10.1542\/peds.2022-058227","article-title":"Disparities in Pediatric Mental and Behavioral Health Conditions","volume":"150","author":"Hoffmann","year":"2022","journal-title":"Pediatrics."},{"key":"2026100507370579900_r19","article-title":"Adversity in Early Childhood","author":"Novoa"},{"issue":"2","key":"2026100507370579900_r20","doi-asserted-by":"crossref","first-page":"e20151839","DOI":"10.1542\/peds.2015-1839","article-title":"Adverse Experiences in Early Childhood and Kindergarten Outcomes","volume":"137","author":"Jimenez","year":"2016","journal-title":"Pediatrics."},{"key":"2026100507370579900_r21","doi-asserted-by":"crossref","first-page":"115106","DOI":"10.1016\/j.psychres.2023.115106","article-title":"Mental health problems of black and white children in a nationally representative epidemiologic survey","volume":"321","author":"Bommersbach","year":"2023","journal-title":"Psychiatry Res."},{"key":"2026100507370579900_r22","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.jad.2024.07.121","article-title":"Associations of adverse childhood experiences with depression and anxiety among children in the United States: Racial and ethnic disparities in mental health","volume":"362","author":"Matthews","year":"2024","journal-title":"J Affect Disord."},{"key":"2026100507370579900_r23","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.jpeds.2021.09.016","article-title":"Adverse Childhood Experiences and Healthcare Utilization of Children in Pediatric Emergency Departments","volume":"240","author":"Okeson","year":"2022","journal-title":"J Pediatr."},{"issue":"2","key":"2026100507370579900_r24","doi-asserted-by":"crossref","first-page":"e20191765","DOI":"10.1542\/peds.2019-1765","article-title":"The Impact of Racism on Child and Adolescent Health","volume":"144","author":"Trent","year":"2019","journal-title":"Pediatrics."},{"issue":"9","key":"2026100507370579900_r25","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1002\/jclp.22781","article-title":"Longitudinal relations between trauma-related psychological distress and physical aggression among urban early adolescents","volume":"75","author":"Thompson","year":"2019","journal-title":"J Clin Psychol."},{"issue":"12","key":"2026100507370579900_r26","doi-asserted-by":"crossref","first-page":"2321","DOI":"10.2105\/AJPH.2014.302046","article-title":"Aggressive policing and the mental health of young urban men","volume":"104","author":"Geller","year":"2014","journal-title":"Am J Public Health."},{"issue":"11","key":"2026100507370579900_r27","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/j.jaac.2022.04.020","article-title":"Social Determinants of Health, Structural Racism, and the Impact on Child and Adolescent Mental Health","volume":"61","author":"Cotton","year":"2022","journal-title":"J Am Acad Child Adolesc Psychiatry."},{"issue":"1","key":"2026100507370579900_r28","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1001\/jamapediatrics.2021.2929","article-title":"Police Exposures and the Health and Well-being of Black Youth in the US: A Systematic Review","volume":"176","author":"Jindal","year":"2022","journal-title":"JAMA Pediatr."},{"issue":"30","key":"2026100507370579900_r29","doi-asserted-by":"crossref","first-page":"e2106272118","DOI":"10.1073\/pnas.2106272118","article-title":"Contact with Child Protective Services is pervasive but unequally distributed by race and ethnicity in large US counties","volume":"118","author":"Edwards","year":"2021","journal-title":"Proc Natl Acad Sci U S A."},{"issue":"1","key":"2026100507370579900_r30","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1177\/10775595211070248","article-title":"Inequities in Child Protective Services Contact Between Black and White Children","volume":"28","author":"Thomas","year":"2023","journal-title":"Child Maltreat."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2025-073158\/1958911\/pediatrics.2025073158.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2025-073158\/1958911\/pediatrics.2025073158.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:37:16Z","timestamp":1791200236000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/158\/4\/e2025073158\/208854\/Reducing-Inequities-in-Restraint-Use-in-the"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":30,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,9,10]]},"published-print":{"date-parts":[[2026,10,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2025-073158","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]},"article-number":"e2025073158"}}