The high-risk patient: a profile of acute care psychiatric patients who leave without discharge.

An acute care psychiatric hospital faces the dilemma of maintaining a safe and secure environment for its patients while gradually providing them with enough independence to assume responsibility for the management of their own behaviors. When patients leave the hospital building, grounds, or an off-ground activity without prior authorization from the attending physician or if they do not adhere to restrictions during a medical/therapeutic pass, they are placing themselves, the hospital, and others in a high-risk situation. An analysis and review of the closed medical records of patients who had eloped were conducted to determine if a pattern existed among them. The medical records studied included clinical notes, assessments, physician's orders, precautions and restrictions, lengths of stay, notes on the hospital environment, and patient-specific demographic data. The findings suggest that there are some consistent factors related to patient elopements that, when recognized, may help clinicians decrease this highly disruptive behavior.