Triage in the Emergency Room is a rapid assessment used to prioritize patients based on the severity of their condition, not a definitive diagnosis. If a patient chooses to leave after this initial evaluation but before receiving complete medical care, this is formally recognized as self-discharge or “leaving against medical advice” (LAMA). Leaving at this stage introduces serious medical risks, initiates a specific administrative procedure for the hospital, and creates financial liability for the patient. Understanding these consequences is important for anyone considering leaving the emergency department prematurely.
Immediate Medical Risks of Leaving
Leaving the Emergency Room after triage means the underlying medical condition remains untreated and could rapidly worsen. Triage determines a patient’s need for prompt attention, but it does not rule out serious health threats such as sepsis, acute cardiac events, or a stroke. Patients presenting with symptoms like chest pain or shortness of breath who leave prematurely face a higher risk of myocardial infarction or respiratory failure at home, where immediate help is unavailable.
A major danger is that the preliminary triage score, based on initial symptoms and vital signs, can be misleading. Triage is not a comprehensive medical screening examination, meaning a potentially life-threatening condition may still be in its early, less severe stage when the patient decides to leave. Patients who leave against medical advice face significantly higher rates of hospital readmission and an increased risk of mortality, especially for conditions like asthma or unstable angina. By leaving, the patient misses the full diagnostic workup, such as blood tests or imaging, that would confirm or rule out a serious illness, resulting in a dangerous delay of treatment.
The Administrative Procedure of Self-Discharge
When a patient expresses the intent to leave before treatment is complete, hospital staff will engage in a formal process known as “informed refusal.” The care team will explain the potential risks of leaving, including the likelihood of their condition worsening, permanent disability, or even death. This discussion ensures the patient has the mental capacity to make an informed decision and fully comprehends the consequences of their choice.
Staff will request the patient to sign a form documenting that they are leaving Against Medical Advice (AMA). This AMA form is a formal acknowledgment that the patient has been informed of the risks and accepts full responsibility for any negative outcomes resulting from self-discharge. The form serves to release the hospital from liability related to the patient’s refusal of care. Even if the patient refuses to sign, the healthcare provider will meticulously document the entire encounter, including the specific risks explained and any offered follow-up care. This documentation provides a legal record of the hospital’s attempt to provide care.
Financial Implications for Services Rendered
A common misconception is that leaving the Emergency Room voids any charges, but the patient remains financially responsible for all services rendered up to the point of departure. This includes the initial triage assessment, any physician evaluations, and the cost of diagnostic tests. If blood was drawn or an X-ray was performed, the patient will be billed for those specific services.
The financial liability covers the use of hospital resources and professional time, even if the patient did not receive a final diagnosis or definitive treatment. For patients with insurance, leaving AMA generally does not automatically cause a refusal of payment for services already provided. However, self-discharge may lead to increased scrutiny from the insurance company if the patient requires readmission soon after for the same, worsened condition. The patient is still responsible for any applicable copayments or meeting their deductible related to the emergency department visit.
Consequences of Leaving Without Notification
If a patient simply walks out of the Emergency Room without speaking to staff or signing documentation, the departure is categorized as “Left Without Being Seen” (LWBS) or “elopement.” This unannounced departure does not eliminate billing for services already performed, such as the initial triage or registration fees. Hospital staff must document the event in the patient’s chart as an unauthorized departure.
The primary concern for the hospital in this scenario is the patient’s safety, especially if the triage assessment indicated a potentially unstable condition. If the patient’s presentation was concerning, the hospital’s duty of care may necessitate a search, involving attempts to call the patient or their emergency contacts. In rare cases where a patient lacks decision-making capacity or is in imminent danger, staff may contact local law enforcement to help locate the individual. This action is taken due to the high risk of severe harm or death associated with an unreviewed departure.