Effectiveness of enhanced post-restraint debriefing in reducing repeated physical restraint: a retrospective pilot study of psychiatric inpatient units in Hong Kong, China

Objective Physical restraint (PR) prevalence is notably higher in Asian psychiatric settings, and in Hong Kong, China; a recent study reported a rate of 0.43 episodes per patient admission. While “No Force First” philosophies and post-restraint debriefing are promoted to minimize PR’s detrimental effects, their implementation is often inconsistent and unstructured, lacking evidence-based frameworks. Methods This retrospective observational pilot study evaluated an enhanced post-restraint debriefing (EPRD) framework, developed by psychiatric nurses and comprising 11 essential topics. Conducted over 3 months from 3 psychiatric units in Hong Kong, China. It included 112 patients who experienced PR due to aggression. The primary outcome was the prevalence of repeated PR within 14 d. Nurses could choose to use EPRD or conventional post-restraint debriefing (CPRD). Fidelity was measured using a checklist; sessions covering ≥8 topics were deemed valid EPRD. Data were analyzed using chi-square tests, t -tests, and effect sizes (Cohen’s d ). Results The repeated PR rate was significantly lower in the EPRD group ( n = 72, 33.3%) compared with the CPRD group ( n = 40, 55.0%) (χ 2 = 4.99, P = 0.026). EPRD was associated with a 59% reduction in odds of repeated restraint (odds ratio [OR] = 0.41, 95% confidence intervals [CI]: 0.19–0.90), an absolute risk reduction (ARR) of 21.7%, and a number needed to treat (NNT) of 5. EPRD sessions were significantly more comprehensive, addressing a mean of 9.88 checklist items versus 4.33 in CPRD ( P < 0.001, d = 4.26), without a significant increase in debriefing duration. Conclusions The implementation of a structured EPRD framework was feasible and associated with a significant reduction in repeated PR incidents without adding time burdens. This pilot demonstrates that standardizing post-incident debriefing content is effective strategy for reducing coercion in psychiatric inpatient care. The findings strongly support the need for larger, prospective, and randomized controlled trials to confirm these results and further validate the EPRD framework across diverse settings.