Cognitive

Patient Elopement

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Patient Elopement, Medical Elopement, Elopement Precautions, Left Without Being Seen, LWBS

  • See Also
  1. Informed Consent
  2. Consent for Treating Minors
  3. Against Medical Advice
  4. Decision-Making Capacity
  5. CURVES Mnemonic for Capacity Assessment
  6. Competency Hearing
  7. Risk Management
  • Definition
  1. Elopement
    1. Patient makes an intentional, unauthorized departure from a 24-hour medical facility (e.g. Emergency Department)
    2. Patient leaves typically without notifying facility staff of their intent to leave
    3. Differs from leaving Against Medical Advice
      1. Leaving AMA requires a patient with full Decision-Making Capacity and
      2. Leaving AMA requires a consent process in which patient is informed of the risks
  2. Wandering
    1. Patient with diminished cognitive capacity walks away unintentionally
      1. Leaves a 24-hour medical facility (e.g. Nursing Home)
    2. Differs from Elopement
      1. Wandering patient is not intentionally leaving the confines of the facility
  3. Left Without Being Seen (LWBS)
    1. Patient leaves healthcare facility (e.g. ED) before healthcare clinician (e.g. MD/DO, NP, PA) evaluation
    2. Patient leaves despite registering for care and often after undergoing triage process
    3. LWBS is a common complication of ED crowding and long wait times
  • Precautions
  1. Elopement and wandering are high risk situations
  2. Many patients who elope have decreased Decision-Making Capacity (e.g. Delirium, Dementia)
  3. JCAHO considers serious adverse events (e.g. Suicide, death) following elopement to be sentinel events
    1. Adverse events after elopement are attributed to that facility
  4. Left Without Being Seen (LWBS) is also associated with increased short-term mortality
    1. McNaughton (2024) J Am Coll Emerg Physicians Open 5(6):e13299 +PMID: 39703807 [PubMed]
  5. Outcomes of leaving before treatment is complete (LBTC)
    1. High rate of more severe illness and returns requiring hospitalization
    2. Smalley (2021) West J Emerg Med 22(2): 148-55 [PubMed]
  • Management
  1. Search for all missing patients within the facility (e.g. syncopal, incapacitated patient in a remote bathroom)
  2. Call the patient's home and invite them to return for continued care (document the phone call)
  3. Medical providers are responsible for informing patients of positive tests resulting after they have left the ED
  4. Indications to contact police
    1. Patient is thought to be a danger to self or others
    2. Serious medical condition which has not been stabilized and they cannot be contacted
    3. Inadequate Medical Decision-Making Capacity
  • References
  1. Henry (2013) Avoid Being Sued, EM Bootcamp, CEME