To define the process for following up with patients who leave the emergency department after arrival, but before
they have been dispositioned from the ED.
The Emergency Department (ED) staff will encourage the patient to be evaluated by a physician or advanced
practice provider (APP). If the patient refuses, ED staff will follow the procedure outlined below.
Elopement: When a patient hospitalized in the Clinical Decision Unit leaves the hospital without being discharged
and before he/she can be informed of the risks and consequences of such leaving.
Against Medical Advice (AMA): When a patient leaves inpatient/outpatient areas against advice. Patient informed
by member of healthcare team about risks and consequences of leaving.
Left Without Being Seen (LWBS): If patient leaves inpatient/outpatient areas prior to APP/MD/DO (including
resident or attending) evaluating the patient. Patient could leave from waiting room, from exam room, or after
Left Before Exam Complete (LBEC): If the patient has been evaluated by APP/MD/DO (including resident or
attending and CareStart physician) and leaves prior to be being discharged and before he/she can be informed of
the risks and consequences of leaving.
1. In the event the Patient verbalizes intent to leave after APP/MD/DO evaluation
a. ED staff encourages patient to wait to discuss further with APP/MD/DO.
b. APP/MD/DO will be made aware of the patient’s desire to leave by primary RN, CTL or delegate.
c. APP/MD/DO will inform patient of the risks and consequences of his/her leaving.
i. This discussion between the patient and physician must be documented in the
electronic health record (EHR).
ii. If after this discussion, the patient still insists on being discharged, hospital staff should
attempt to have the patient read and sign the AMA form (UWH#335 ).
d. A patient is not allowed to discharge him or herself AMA if the patient is under commitment
orders or lacks decision-making capacity. In addition, minors, unless they have admitted
themselves, may not be discharged AMA without the consent of a parent. If a patient attempts
to leave under these circumstances, the Department of Patient Relations or the Administrator
On-Call should be notified and Hospital Security should be called for assistance (telephone 890-
e. If the patient refuses to sign the form, ED staff will document refusal in Health Link and complete
f. ED staff will notify the ED Administrative Physician and document in Health Link.
2. In the event the Patient verbalizes intent to leave prior to APP/MD/DO evaluation
a. ED staff encourages patient to wait to be evaluated by APP/MD/DO.
b. ED staff notifies ED RN
c. ED RN attempts to have a conversation with patient
i. If the patient refuses to wait, ED staff asks the patient to sign form LWBS#4005876
(Record of Patient Who Leaves Before Medical Screening Can Be Performed)
d. If the patient refuses to sign the form, ED staff will document refusal in Health Link and complete
e. ED staff will notify the ED Administrative Physician and document in Health Link.
3. Patient leaves without informing ED staff
a. ED staff documents in Health Link that the patient left without notifying staff.
a. ED Case Manager generates a daily LWBS/LBEC/AMA/Elopement report.
i. Log into HL
ii. Click on "Reports" tab along the menu tab.
iii. Click on "Census Snapshot Report".
iv. Click on "LWBS Report"
v. Select "Run" tab
vi. Select date/ time range and click "Refresh"
vii. Scroll down to appropriate section.
5. At University Hospital an ED Case Manager will attempt to contact each patient within 36 hours after ED
visit. At The American Center ED, the care team leader or designee will attempt to contact the patient
within 36 hours after the ED visit.
a. Two phone calls at different times of day
b. No telephone messages will be left (confidentiality)
c. A note will be entered in HL with the outcome of the phone calls
ED Case Manager,
ED Clinical Operations Committee
Director, Emergency Services
V. SIGNED BY
Clinical Vice Chair, Department of Emergency Medicine
Director, Emergency Services
Director, Perioperative and Emergency Services
The American Center