When Patients Wander

(from the February 2018 ACP Hospitalist)

Hospitals need detailed policies on patient elopement to avoid this sentinel event and protocols for responding when it does happen.

By Janet Colwell

One very cold February morning in Iowa, a young man was admitted to the ED of a community hospital for a behavioral health evaluation. After an hour or so, he asked to leave, but before he could be discharged, he walked outside, breaking into a run and disappearing into the distance when a security guard tried to detain him. Seventeen days later, he was found dead from exposure.

“It was a sentinel event that caused us to review our policies and procedures regarding elopement,” said James Lehman, MD, FACP, vice president of medical affairs at Wheaton Franciscan Healthcare, a nonprofit health care system with three acute care hospitals in Iowa. “Everyone on our staff is acutely aware of the need to prevent at-risk patients from leaving without supervision.”

Most hospitals have policies and procedures around patient elopement and wandering, which The Joint Commission considers sentinel events, defined as unanticipated events in a healthcare setting that result in death or serious physical or psychological injury not related to the natural course of a patients' illness. However, it's easy for the issue to fall off the radar in a hectic acute care hospital where clinicians have many competing urgent priorities and patients are constantly coming and going.

“Many organizations underestimate how potentially devastating elopement can be,” said Dr. Lehman. “If you have a patient who elopes who isn't capable of self-preservation or sound decision making, it's a very serious issue which can result in significant harm to the patient.”

The definition of elopement includes patients who depart from a facility unnoticed, even if they don't make it off the grounds. To prevent such events, hospitals must do more than simply have a policy on the books, experts say. Assessment, prevention, and response strategies must be integrated into the daily workflow and prioritized by leadership.

“Hospitals need common procedures for identifying and supervising patients at risk and mounting an immediate response when someone goes missing,” said Meredeth Rowe, RN, PhD, a professor of nursing at the University of South Florida in Tampa who has written about preventing elopement in patients with dementia. “The first hours of a search are critically important—the longer someone remains missing, the less likely it is they will be found alive.”

Read the full article in ACP Hospitalist.

ACP Hospitalist provides news and information about hospital medicine, covering the latest trends and issues in the field.

Back to the April 2018 issue of ACP IMpact