Patients Leaving the Emergency Department Prior To Completion of Care

Originally approved September 2025

The responsibility of an emergency physician is to use their experience and expertise to evaluate, examine, and appropriately disposition all patients presenting for emergency care. This typically involves some combination of a patient interview, physical examination, testing, treatment, and disposition in conjunction with a patient discussion and explanation of the current and ongoing plan of care. Unfortunately, this cannot always be accomplished if the patient voluntarily leaves the emergency department (ED) before completion of treatment. This could occur at any stage of care and may involve the patient being formally discharged against medical advice, eloping, or leaving for any other reason.

While it is incumbent on the emergency physician to communicate with the patient to the best of their ability, if a patient does leave before the completion of treatment, it must be acknowledged that the patient may not have received all typical and expected care, including, but not limited to:

• Necessary or recommended testing
• A complete physical evaluation
• Communication and discussion of pertinent testing results
• Appropriate treatment for any identified medical condition
• Recommended consultation with other physicians
• Communication or arrangement of follow-up care
• Discussion of reasons for return, ongoing concerns, and other outstanding care at the time of discharge

More specific to the discharge process, patients who leave the ED before the completion of treatment may also do so without:

• Appropriate medication recommendations
• Prescriptions for recommended medications, devices, care, or other treatments
• Information on transitions of care and recommended outpatient care
• A complete list of discharge diagnoses and findings
• Knowledge of incidental and related finding necessitating follow-up

For the above reasons, when a patient elects to leave before the completion of treatment, it creates inherent risks for the patient. These risks are brought on by the patient's decision to leave before care is concluded. The hospital/facility must have a process to inform and discuss the risks of leaving and document that the patient has been counseled that they may not have received the results of all testing and that the patient has a responsibility to follow up to obtain those results. However, this may not be possible in all cases. Additionally, patients should be informed that they should seek follow-up care as soon as possible, which may include returning to the ED for completion of emergency care.

ACEP believes that the hospital/facility must have a defined process for notifying patients who leave before the completion of treatment, whether from the ED or any other unit within the hospital, of the results of laboratory or diagnostic imaging testing that require follow-up.

ACEP believes the treating emergency physician is not directly responsible for notifying patients of test results when the patient leaves before the completion of treatment, especially if the patient left before being evaluated by that physician; then this responsibility lies with the hospital/facility, not the emergency physician.