Absconding: reducing failure to return in adult mental health wards

Abstract

Failing to return from leave from acute psychiatric wards can have a range of negative consequences for patients, relatives and staff. This study used quality improvement methodology to improve the processes around patient leave and time away from the ward. The aim of this study was to improve rates of on-time return from leave by detained and informal patients by 50%.Following a baseline period, four interventions were implemented and refined using PDSA cycles. The main outcome measure was the proportion of periods of leave where the patient returned on time. Late return was defined as failure to return to the ward within 10 minutes of the agreed time.At baseline, the rate for on-time return was 56.0%; this increased to 87.1% post-intervention, a statistically significant increase of 55.5%. SPC charts show that the interventions were associated with improvements. The improvements have been sustained and the interventions are fully embedded into daily practice. The project was refined to local context and trialled on six additional wards: four of the six wards have successfully implemented the interventions and have on-time return rates of over 90%.This project produced a marked and sustained improvement in patients returning on-time from leave, facilitating a more open discussion between staff and patients about the purpose and value of periods away from the ward. Quality improvement approaches can be effectively applied in mental health settings.

Development of a checklist to aid in the assessment of ‘failure to return’ from approved leave by acute inpatients

“…Authorised leave from the acute ward gives consumers an opportunity to address their affairs and to reconnect with their community in a graduated way (Bailey et al . ). Authorised leave is also being increasingly used to enable consumers to smoke off campus following the introduction of ‘no‐smoking’ policies in Australia and overseas (Bailey et al .…”

“…Authorised leave is also being increasingly used to enable consumers to smoke off campus following the introduction of ‘no‐smoking’ policies in Australia and overseas (Bailey et al . ). Notwithstanding the benefits of approved leave, a small but significant proportion of consumers breach leave conditions by failing to return on time or not at all from periods of leave (Bailey et al .…”

“…Notwithstanding the benefits of approved leave, a small but significant proportion of consumers breach leave conditions by failing to return on time or not at all from periods of leave (Bailey et al . ; Muir‐Cochrane et al . ; Gerace et al .…”

“…Failure to return from leave can have negative consequences for the consumer, staff and social climate of the inpatient unit (Bailey et al . ; Hunt et al . ).…”

Seeking freedom: A systematic review and thematic synthesis of the literature on patients' experience of absconding from hospital

“…Some of the literature also examines measures to reduce absconding through restrictive interventions, such as locking ward doors (Nijman et al, 2011;Stewart & Bowers, 2011;Van der Merwe, Bowers, Jones, Simpson, & Haglund, 2009), enhanced observations (Stewart, Bowers, & Ross, 2012) and using GPS location devices to monitor patients' whereabouts (Hearn, 2013). Other studies approach the phenomenon through a more therapeutic lens and focus on models of care to reduce absconding, as well as education and support (Bailey, Page, Ndimande, Connell, & Vincent, 2016;Bowers et al, 2014Bowers et al, , 2005Bowers, Alexander, & Gaskell, 2003;Bowers, Brennan, Flood, Lipang, & Oladapo, 2006). However, even this work often takes the perspective of nursing staff or the healthcare organization, rather than patients.…”