The patient who absconds
Introduction
Patients who leave the emergency department (ED) without staff knowledge combine clinical risk, legal complexity and operational challenge. Absconding can produce immediate harm (for example from intoxication, withdrawal, suicidal behaviour or delirium) and delayed consequences (missed treatment, deterioration).
ED teams must therefore identify patients at risk early; assess capacity specifically for the decision “to leave the ED now”; prioritise observation and liaison psychiatry; use lawful, proportionate measures if restraint is considered; and document contemporaneously. (RCEM; MCA Code; NICE NG225)
Definition
“Absconding” - 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)
Why this matters
- Duty of care: once a patient is booked into the ED a duty of care applies and staff must take reasonable steps to mitigate foreseeable risks.
- High‑risk presentations: intoxication, withdrawal, active suicidal ideation/self‑harm, acute psychosis, delirium, medical instability, children and other vulnerable adults.
- Medico‑legal exposure arises if capacity is not assessed/documented or local protocols are not followed.
Identification and triage
Screen for abscond risk at triage. Include a clear prompt and record the patient’s answers and the assessor’s view. Useful direct questions are: “Do you understand the plan?” and “Do you want to leave now?”...