As a supposed measure of last resort, however, restraints are surprisingly common. A 2007 study in the Journal of Nursing Scholarship estimated that 27,000 patients are restrained every day in U.S. hospitals—an average of five patients per hospital per day.

In some situations, restraints may be ineffective and even harmful. Doctors and nurses often employ restraints when a patient is at risk for falling or delirious. However, evidence suggests that restraints do not reduce one’s risk of falling. Likewise, a study in the Journal of the American Medical Association suggested that restraints increase the risk of delirium in the hospital by 4-fold, possibly by increasing patients’ levels of anxiety and stress due to involuntary immobilization. Physical restraints and the resulting immobilization they cause are also associated with increased rates of pressure ulcers, respiratory complications—and even death via strangulation and aspiration. Even more disturbingly, a 2006 report by the U.S. Department of Health and Human Services concluded that hospitals failed to report more than 40 percent of deaths related to restraints to The Centers for Medicare and Medicaid Services (CMS).

Though these statistics may make the ICU seem like an asylum, it is not. The majority of patients I cared for in the ICU never required restraints. And for the others who were confused or agitated, our team could usually avoid restraints by adjusting or prescribing medication.

However, as one of my senior residents confided in me, when caring for the sickest patients in the hospital, restraining a delirious patient might be the only way to devote time to other seriously ill patients. On that busy night during my ICU rotation (which happened before I came to Brigham and Women's Hospital, where I work now), there were other patients suffering from life-threatening infections, failure of multiple organs, or other conditions that put them on the cusp of death. They needed our attention. And yet watching those three patients fighting against their restraints, becoming more delirious with the very devices used to manage their delirium, was one of the most troubling things I witnessed as a medical student.

At its annual meeting this year, the American Geriatrics Society (AGS) released a recommendation that healthcare providers avoid using physical restraints to manage behavioral symptoms of hospitalized delirious adults. Dr. Caroline Vitale, associate professor of medicine at the University of Michigan, presented the recommendation at the AGS Annual Meeting, where she highlighted innovative efforts by some groups to reduce restraint use. Some physicians are using devices, such as shields around IV or central line sites, to protect medical interventions without restricting patient movement. Another hospital is redesigning an entire ward to be “restraint-free” through steps like providing mobility aids in all rooms so that patients can move around safely when they want to.