Evaluating left without being seen and against medical advice departures in a rural emergency department

Emergency nurses encounter debate regarding disposition of patients eloping, leaving without being seen (LWBS), and exiting against medical advice (AMA). The controversy arises as patients exit unpredictably and while accurately documenting these events. What impairs nursing performance and contributes to incomplete documentation of patient elopement? How do nurses identify, label, and categorize abnormal patient departures? This study answers these questions, defining categories of patient elopement from ED care. The discussion explains the dangers associated with high volumes of LWBS and AMA departures from emergency care and suggests strategies to improve patient satisfaction. Imagine that a visit to the emergency department simulates a rollercoaster ride. Rollercoaster attendants expect passengers to enter the ride,buckle seatbelts, and remain seated. Rules forbid passengers from leaving until the ride completely stops. At the ride’s end, seatbelt mechanisms release and passengers exit. Get on. Ride. Get off. What happens if someone wants to get off in the middle of the ride? Riders panic on the way up the first peak. Passengers change their minds during an upside-down loop-deloop. Anxiety drives people to jump off before carts completely stop. Safeguards exist preventing these exits, stopping riders from getting hurt. ED patient flow simulates this rollercoaster. If patients depart too early, health care professionals’ ability to ensure patient safety disintegrates. Nurses cannot predict unfortunate events occurring after discharge, but completing treatment and obtaining discharge teaching increase certainty that patient departures will result in survival rather than disaster. The discharge interaction also provides nurses with one final opportunity for interaction, observation, and assessment of each patient.