Negligence when a patient leaves?

joeb1, ASN, BSN, RN · May 18, 2013

I would guess that as they were not even registered and assuming they were not suicidal and you knew about it, I would say it is there right to make the decision to seek treatment elsewhere. If they decided thus, I think the only people who could be considered negligent is the family for not wanting to wait.

SweetMelissaRN · May 18, 2013

I would guess that as they were not even registered and assuming they were not suicidal and you knew about it I would say it is there right to make the decision to seek treatment elsewhere. If they decided thus, I think the only people who could be considered negligent is the family for not wanting to wait.[/quote']
You have zero liability for them not wanting to wait. Did you get vitals or triage them? If they were medically stable and in no signs of distress I can't imagine your hospital being held accountable for anything. What was the diagnosis, just out of curiosity?

psu_213, BSN, RN · May 18, 2013

And if the pt wants to leave, there is no way you can make them stay (presuming not suicidal nor homicidal)

besaangel, ASN, BSN, MSN, CNA, RN, APRN, NP · May 19, 2013

And if the pt wants to leave, there is no way you can make them stay (presuming not suicidal nor homicidal)

Agreed bcause where I work, pts up and leave all the time (especially the non-emergent who didnt need to be there in the first place)... And I'm like, why did you come in the first place, get registered, come to xray and CT, then bounce??? You know you are gonna be charged right?

We are a level 1 trauma center so Im sorry that your throat itches but I have a MVC coming over with mangled limbs... but some pts just dont get that part. Your throat can wait, but the trauam needs to get to OR to save their extremities while your mad abt a sore throat... ridiculous

besaangel, ASN, BSN, MSN, CNA, RN, APRN, NP · May 19, 2013

*trauma

That Guy, BSN, RN, EMT-B · May 20, 2013

I dont stop people from leaving. End of story. You are a big boy/girl. If you want to leave then do it. The way I look at it is this. You are here for a reason. You hurt, cant stop leaking from both ends, cant find your narcs, whatever. If you can make the decision to leave then I dont care. No skin off my back. Here is your AMA and be gone.

Now if you are trying to die or going to kill someone/yourself, thats different. But for general population that 9/10 times doesnt need to be there, buh bye.

turnforthenurse, MSN, NP · May 21, 2013

If the pt wants to leave, I let them leave, as long as there is no 5150 hold on them. Give them the AMA papers and get them out of there. We need more beds, lol.

Now, I I have a patient wanting to leave but they are critical or are going to be admitted, that's different. You still cannot force somebody to stay, though, as long as they are in the right state of mind.

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Altra, BSN, RN · May 21, 2013

Please note that the OP has asked about a very specific scenario -- the patient who physically presents to the ED, but does not go through whatever registration process is in place, is not triaged, and decides to leave. The OP is not asking about patients who sign out AMA or elope during treatment.

This is a situation that can be anxiety-producing even for an experienced triage nurse. Remember ... per EMTALA ... if the patient is within 250 yards of the hospital ... they are the responsibility of the emergency department if anything happens to them. So the patient physically standing in the waiting room, even for 30 seconds, certainly falls within that category. As I read the OP, the situation was further complicated by the apparent involvement of family members of the patientin making the decision to leave ... so you have an additional layer of potential for someone to act in a manner not in the best interest of the patient. OP does not indicate whether this means that the patient was a pediatric patient, or perhaps in a wheelchair and therefore somewhat at the mercy of the person physically moving him/her around, or was not either of those things, but just simply swayed by the opinions of family members so as not to make a fuss.

This does expose the triage nurse to some liability under EMTALA. When I have had this situation occur I have greeted the patient, asked why they are seeking care today, and politely but strongly encouraged them to stay. Verbal persuasion comes into play here. While I wholeheartedly agree that people need to be responsible for their own decision-making, and the old ER adage that "if you can complain about the wait time, you're probably not really experiencing an emergency" ... but that doesn't change the current regulatory/legal environment.

Adenosine6 · May 22, 2013

To put it simple (15 + yrs in an ER), the best thing is when they AWOL (unless they are 5150's / non-altered).

AWOL - They have taken it upon their-selves to leave without notifying any staff. No need to go over an AMA or advising them to stay.

Simple charting "Pt AWOL, not found in room nor WR. No answer to the number provided; left message, MD informed."

This is coming from an ER RN that doesn't put up with that crap.

Altra, BSN, RN · May 22, 2013

To put it simple (15 + yrs in an ER), the best thing is when they AWOL (unless they are 5150's / non-altered).
AWOL - They have taken it upon their-selves to leave without notifying any staff. No need to go over an AMA or advising them to stay.
Simple charting "Pt AWOL, not found in room nor WR. No answer to the number provided; left message, MD informed."
This is coming from an ER RN that doesn't put up with that crap.

AWOLs are problematic when the patient has potentially left with an IV in place. And even without that complication, AWOLs must be reported to the state health dept. in my state. So I can't agree that it's "the best thing."

The OP's question isn't related to AWOLs, but to the specific time period between the patient physically walking in the ER doors and leaving without being registered.

psu_213, BSN, RN · May 22, 2013

AWOLs are problematic when the patient has potentially left with an IV in place. And even without that complication, AWOLs must be reported to the state health dept. in my state. So I can't agree that it's "the best thing."

We have to report them in my state as well (it goes by a slightly different term than AWOL) and, apparently, we get fined each time we don't report it. In addition, unless we see them leave we must have 3 people search the dept., each 10 minutes apart (and chart it) before we can 'officially' declare them an AWOL.

If they have an IV in place when they leave, we have to call the police.

I agree that, either way, it is probably not the "best" option.