Patient self discharge from the emergency department: who is at risk?

OBJECTIVES: To identify the number of patients who take their own discharge, to review how their competence to make the decision to refuse treatment was being assessed and managed, and to quantify the medical risk to these patients.
METHODS: A retrospective review of all case notes coded as "self discharge" for a three month period. A second cohort was reviewed following the introduction of a new self discharge proforma.
RESULTS: Patients who self discharge represented 0.5% of the total number of attendances, and those who "did not wait" represented a further 11%. Fifty percent were under the influence of drugs or alcohol. Sixty three percent refused admission, 24% refused treatment, and 13% refused medical assessment. In the first audit, assessment of capacity was documented in 0%, 58% signed a self discharge form, 25% were reviewed by a doctor prior to leaving, and 31% left the department without the staff's knowledge. In the second audit, capacity was documented in 80%, 80% signed the new self discharge form, 41% were reviewed by a doctor prior to leaving, and 0% left the department without being reviewed. DISCUSSION: Self discharge may be a significant risk to both the patient and the hospital trust. Departments should review their own systems for assessing and managing this patient group. Further work looking at the consequences of self discharge is required.