HospitalInspections.org

Based on document review and interview, it was determined the hospital failed to meet the patient needs by ensuring a safe environment and preventing a patient elopement. This has the potential to affect all patients treated by the Emergency Department with an average of 200 visits daily.

Findings include:

1. The policy titled "Elopement Precautions" (dated 4/2021) was reviewed on 8/5/2021. The policy noted "Procedure: 1. The physician... will order Elopement Precautions after their assessment of the ED (Emergency Department) patient. Elopement precautions are to be used on a patient who is cognitively, physically, mentally, emotionally, and/or chemically impaired and cannot physically leave the department."

2. Pt #1's record was reviewed on 8/5/2021 at approximately 12:20 PM. The record noted Pt #1 was brought to the ED via ambulance on 7/31/2021 at 12:46 PM, for a psychiatric evaluation due to an altercation with the police. An order for Elopement Precautions was obtained and implemented on 7/31/2021 at 1:15 PM. The record noted Pt #1 eloped and left the department on 7/31/2021 at 6:19 PM.

3. During an interview on 8/5/2021 at approximately 1:00 PM, the Director of Patient Safety (E#9) verbally agreed Pt #1 eloped and should not have.