Association between ward structural changes and coercive interventions in psychiatric emergency wards in Japan: a retrospective study.

BACKGROUND: Seclusion and physical restraint (PR) are sometimes required in psychiatric emergency wards for safety, but reducing their use is a key clinical and ethical objective. Although ward features such as private rooms are believed to affect coercive practices, empirical evidence remains limited. METHODS: In April 2020, Hospital A's psychiatric emergency ward relocated to Hospital B, with a slightly reduced bed capacity (46 to 42 beds), increased private rooms, expanded closed-circuit television (CCTV) monitoring, and a centralised staff station. We retrospectively analysed 816 admissions (Hospital A: n = 372; Hospital B: n = 444) before and after relocation. Primary outcomes were seclusion and PR use; secondary outcomes included event count, duration, and days from open observation to termination. Analyses used logistic regression and generalized linear mixed models (GLMMs). RESULTS: Hospital B had fewer patients subjected to seclusion (n = 155) and PR (n = 94). Multivariable analyses showed lower odds of seclusion (odds ratio [OR] = 0.70, 95% confidence interval [CI]: 0.50-0.99) and PR (OR = 0.65, 95% CI: 0.46-0.92). GLMMs showed shorter seclusion duration (β = - 0.281, p < 0.05) and faster transition from observation to termination (β = - 0.386, p < 0.01). PR duration did not differ significantly. CONCLUSIONS: Ward structural changes may reduce coercive interventions.