Patients with an altered mental state who leave facilities are subject to injury and sometimes death. Two recent cases in Illinois demonstrate the danger when a facility loses track of patients or patients simply leave the facility without notice.
“Elopement” is the term used to describe a patient who leaves a healthcare or nursing facility without authorization or discharge. The Joint Commission defines elopement as an “unauthorized departure…of a patient from a staffed around the-clock care setting (including the ED), leading to death, permanent harm, or severe temporary harm to the patient.” The Joint Commission considers elopement as a sentinel event. A sentinel event is a safety incident that results in permanent harm, severe temporary harm, or death and is the most serious level of harm event investigated by The Commission.
In July of this year, two people went missing from the same hospital in Illinois—one survived and one did not. Elopement also occurs in assisted-living and nursing facilities by patients who may lack the mental capacity to understand they are leaving; they simply wander away. Other patients, who have the capacity to understand their condition and their whereabouts, may choose to leave a hospital of their own accord or “against medical advice (AMA).”
In the Illinois matter, a 35-year-old hospitalized man who without the capacity to understand his actions left the facility. Police initiated a search and the man was found safe the following day.
In another incident in the same hospital, a 61-year-old woman was taken to the ED by a family member. The woman suffered from Huntington’s Disease. Huntington’s Disease is progressive neurological disease that impacts cognitive ability and causes functional and movement impairment. After being briefly seen in the ED, the woman walked out of the facility, without being discharged, around 7:00 PM. A large-scale search was launched, including the use of canines and drones. One of the dogs led searchers to a retention pond on the far end of the hospital grounds. A drone flown over the pond located the patient unresponsive in the water. She was recovered and pronounced dead.
For patients with clinical or behavioral profiles that may cause them to wander, hospitals and other care facilities must be vigilant to avoid patient harm or injury. In these cases, it is not clear the facility was aware of the elopement possibility of either patient.
Regardless of age, people without the capacity to keep themselves safe require that facilities put protocols and protections in place to protect their most vulnerable patients.
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