How Technology Can Help Prevent Patient Elopements

Access control, visitor management, software, video surveillance and improved policies can reduce the likelihood of at-risk patients bolting and endangering themselves.
Published: April 23, 2014

According to the National Autism Association (NAA), about half of all families living with children who have Autism Spectrum Disorder (ASD) report an episode of wandering. The NAA further reports that eloping (or bolting) – defined as leaving a safe location without asking permission or being given a direction to do so – led to 22 deaths in 20 months between 2009 and 2011. Those who are at greatest risk, both for elopement and for the hazards that may follow, are individuals with intellectual or behavioral difficulties. Those who possess little to no verbal skills, as well as those who do not respond to their names are particularly vulnerable.

While elopement is a significant issue within a variety of environments, hospitals and healthcare institutions have their own set of circumstances. Often individuals who bolt do so due to anxiety or overwhelming situations, which they are more likely to experience in a healthcare facility. In this setting, they are not directly supervised at every moment, they may not be feeling well and they are separated from their families or their regular caregivers, often for lengthy periods of time.

Additionally, whereas a school holds the same population of students and teachers for a full school year, patients, nurses and doctors come and go in hospitals, and the population is constantly changing. This makes the set of prevention standards currently disseminated among administration in school districts – which include education to help professionals recognize when children are at risk for elopement – less effective when it comes to a hospital setting.

However, healthcare facilities do present one very specific advantage over schools: many already have access control systems in place. Adding more control points (both for entrance and for exit) is more likely to be accepted in a hospital than it would be in a school, although the tide is beginning to turn in schools as well.

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Combo of Technologies Reduces Liability Exposure

To help ensure that all patients entrusted to a healthcare campus are provided a secure environment in which they can safely heal, it is necessary to protect them both against danger coming in from the outside, and against their own impulses to leave the premises when it is not safe or authorized for them to do so. One key issue is that it is actually not physically difficult for an individual to bolt, especially in a busy hospital where people are constantly coming and going and personnel are extremely busy.

There is no single solution that solves this dilemma; however, with a combination of technologies it is possible to reduce elopements and protect patients from impulses that would put them in danger. More and more institutions are acknowledging the need for and the value of protection from elopement, particularly with recognition of their own potential liability. If a patient does leave the premises and become injured – a relatively high likelihood for this population – the hospital’s accountability is tremendous and the liability would be as well.

The unacceptable risk was recently highlighted by the tragic death of 14-year old Avonte Oquendo in New York. In October, the boy, who had autism, disappeared after running out of his Long Island City school. His remains were found in Queens in January.

Given the high number of deaths resulting from elopement in the past, the possibility of future incidents must be taken into account by healthcare institutions.

Access Control Is Only the Beginning

The combined solution for healthcare environments begins with physical access control on any doors to wings or hallways housing an at-risk population. These individuals would include any mentally, developmentally or emotionally impaired individuals, those addicted to drugs, or any children. The encoded information for the read-in and read-out access readers can be incorporated into patients’ ID bracelets or on other wearable badging, and all individuals would have to present credentials to come in or to leave that particular floor or area. Putting controls like this on doorways, something that is beginning to gain traction in today’s healthcare facilities, is the first guard against bolting – but it is not enough by itself to prevent the problem.

Once the physical access control infrastructure is in place, it is possible to implement a broader solution to address the problem of elopement. The technology that makes this possible is physical access and identity management (PIAM) software that manages the identities of every individual who is present in the healthcare facility, including patients, staff, visitors and contractors. In order to be able to pass the lobby and enter different parts of the building or campus, an individual must be identified, vetted, authorized and badged for that sector.

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