The purpose of this section is to consider the profile of patients who are at risk for elopement from psychiatric hospitals, how to assess the potential for elopement, to think about the traditional methods that have been used to prevent elopement, and to promote the safety of patients who have eloped, and to think whether or not there are patient safety or quality improvement approaches to preventing elopement or preventing harm during elopement. Elopement needs to be seen as a dangerous event. It increases the risk of injury to the patient and to others in the community. It causes stress or distress for staff members, and it increases the potential for litigation against the facility. Those who are at highest risk for elopement are those with male gender, younger age, patients with no legal history, patients with antisocial personality disorder or other personality vulnerabilities, those with comorbid substance abuse or cravings for substances of abuse, those who have a lack of an adequate therapeutic relationship with the nurses and doctors, those who have impulsivity, those who have concern about others in the community who perhaps haven't voiced those concerns, those who have a history of elopement, and those who may have MMPI personality findings that the patient will be poorly directed, has a high energy level, or those who deny the need for hospitalization. In terms of institutional factors associated with elopement rates, the rates of elopement vary depending on the character of the facility, whether the count is seen as a percentage of all admissions, and whether elopement from a locked or an open unit is considered. There are environmental and system factors associated with elopement, including easy access to the outside or an open-door policy, clustering of elopements occurred during changes of shift or dinner hours and in the days just before the weekend, poor patient-to-staff ratios, a tendency of patients to elope early in the hospitalization, poor communication between and among staff with unclear orders from physicians, poor staff accountability for patients, a perception of the meaning of the hospitalization and treatment needs being poor, the patient's perception of whether it is wrong to leave without authorization, involuntary status, and longer hospital stays. These are all environmental and system factors that are associated with elopement. A patient safety quality improvement approach to elopement is a little bit different. In every psychiatric system, elopement risk has to be addressed at admission, similar to the way that we think about violence risk. The goal is to maintain unit safety while preventing elopement in those individuals who are at risk. Any member of the treating team should be able to identify elopement risk and to share that information with the team. That would be good inter-team communication and teamwork. Another aspect of assessing risk from a patient safety standpoint is that every patient's risk profile must be identified and seen individually. It would be helpful for those patients at risk to have visible alerts posted in an easily seen location, such as the wall in the room where rounds are conducted or at the front of the unit. A newly assigned staff member should be able to see all the patients at risk for violence or elopement and to be able to know who they are more easily. There is no substitute for individual handoffs, and this is important when we're thinking about elopement just as much as we are thinking about suicide or medication errors. Cognitively limited patients are also at an increased risk of elopement as they simply may not know the rules, not appreciate rules, or have greater degrees of impulsivity. Treatment teams should also assign observation levels commensurate with the patient's status. That can frequently be assessed through a multidisciplinary team meeting. Close observation and timeouts in the patient room are some basic methods that can be used to determine the best method for observing the patient. In addition, the treatment team must attain the services of an interpreter when there are language factors, and the need for the treatment to overcome factors that contribute to elopement must be addressed with the patient, particularly those things that may be drawing the patient to leave the hospital, such as the care of young children in the home or the wish to utilize substances of abuse. A checklist can be used and developed to reduce elopement risk. When a team member employs this basic method, are the doors locked? Is the patient restricted to the unit? And so forth. The use of such a basic method is a patient safety method to reduce elopement and to reduce the risk of harm during elopement.

risk factors

prevention methods

patient safety approaches

elopement from psychiatric hospitals

highest risk patients