The association between crowding, natural light, and rates of physical restraints in a New York City community hospital psychiatric emergency room.

Abstract NYC community hospitals serve marginalized groups who face significant healthcare inequities. We hypothesized that low square footage and poor natural light availability is correlated with increased rate of physical restraint, further exacerbating structural injustices. We examined the rate of restraints during a period of temporary relocation of the psychiatric emergency room (CPEP) Aug – Dec 2022, and compared these to the same months in 2021 and 2019. We established the square footage and the surface area of the windows of the original (CPEP A) and temporary units (CPEP B) and compared the rates of restraints between CPEP A (2019, 2021) and CPEP B (2022). CPEP B was found to be 89.78% larger than CPEP A, with greater surface area of windows. Differences were noted in the frequency, total duration, and average duration of restraint in the two spaces; the mean rate of restraints in 2022 (CPEP B) was found to be significantly less than the mean rate of restraints in 2019 and 2021 (CPEP A) (p-value < 0.05). The most important limitation of this study was the low power. This study demonstrates the role of psychiatric emergency room size and availability of natural light in reduction of rates of restraints, especially in urban community hospitals which are disproportionately affected by limited space and cost per square footage. Given the low power of this study, we recommend expanding future data collection.