The absconding patient
practically speaking...
- security involvement
- contacting patient and NOK
RCEM guidance
definition
RCEM guideline (2020) defines ‘absconding’ as a patient who has left the department unexpectedly, without the knowledge of clinical staff, and in whom there remains a potential risk of harm to self or others either through neglect or deliberate means.
RCEM guidance:
- Early assessment e.g. direct streaming to mental health team (where there is no co-existing ‘medical’ problem) or placed in a priority triage category.
- that legendary parallel assessment
duty of care
- when patient books into ED
reducing risk of absconding
- record physical description at triage
- inform patients of time to see clinician
- high risk of self harm and/or absconding = 15 min observations
the setup
- ED should agree with security teams what level of restraint can be provided ....
- ongoing governance in association with police
- local safeguarding
- other agreements with local services e.g. ambulance service
RCEM: risk assessment when someone absconds
- Searching the ED and immediate surrounding area.
- Contacting security to help with the search as well as using CCTV.
- Calling the patient's contact number.
- Consider contacting the next of kin, weighing up the balance of need to ensure safety with patient confidentiality.
contact police if and only if ALL conditions are met:
- real and immediate risk to life
- police assistance (requesting that they urgently locate and return the patient to the Emergency Department) represents a proportional response to the identified immediate risk.
- individual circumstances considered
- efforts to contact patient by telephone have failed
- no other person or service can facilitate the return of the patient - including GP, ambulance services, patient NOK.... .
police cannot bring patient back against their will UNLESS:
- under arrest
- under Section 136... if police believe patient suffering from mental illness
- person is at risk and vulnerable
- if restraint needed >10 min
- document legal basis
- MHA
- MCA, or
- common law: When a patient’s actions put others at immediate risk of significant harm, it is lawful under common law to intervene to prevent that harm, irrespective of their capacity.
on return
- senior decision maker should assess patient