Rev Cuid. 2025; 16(3): 4548

https://doi.org/10.15649/cuidarte.4548

RESEARCH ARTICLE

Characterization of absconding and attempts to abscond in a Colombian general hospital

Caracterización de fugas e intentos de fuga en un hospital general colombiano

Caracterização de fugas e tentativas de fuga em um hospital geral colombiano

Semillero de Investigación en Salud Mental y Psiquiatría (SISME), Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia. E-mail: nicolas.prada@udea.edu.co Correspondence Author Nicolas J Prada
Área de Investigación, Hospital Alma Máter de Antioquia, Medellín, Colombia. E-mail: esteban.castrillonm@udea.edu.co Esteban Castrillón-Martínez
Servicio de Urgencias, Hospital Alma Máter de Antioquia, Medellín, Colombia. E-mail: ana.perez12@udea.edu.co Ana María Perez-Gutierrez
Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia. E-mail: juanp.zapata@udea.edu.co Juan Pablo Zapata-Ospina

Highlights

 

How to cite this article: Prada Nicolas J, Castrillón-Martínez Esteban, Perez-Gutierrez Ana María, Zapata-Ospina Juan Pablo. Characterization of absconding and attempts to abscond in a Colombian general hospital. Revista Cuidarte. 2025;16(3):e4548. https://doi.org/10.15649/cuidarte.4548

Received: October 16th 2024
Accepted: July 10th 2025
Published: October 14th 2025

CreativeCommons 

E-ISSN: 2346-3414

Abstract

Introduction: Patient absconding in healthcare institutions has been associated with negative outcomes for both patients and the institutions themselves. Despite this, few studies have evaluated the frequency and characteristics of these events in Latin America, especially in general healthcare hospitals that do not specialize in psychiatric care. Objective: To describe the sociodemographic and clinical characteristics, as well as the event characteristics, among patients who absconded or attempted to abscond from a tertiary general hospital in Medellín, Colombia, between 2015 and 2023. Materials and Methods: Quantitative, descriptive cross-sectional study using secondary sources, where information was collected from the medical records of patients who absconded or attempted to abscond at the Hospital Alma Mater de Antioquia. A descriptive statistical analysis of the data was performed. Results: A total of 141 events were recorded during the evaluated period (135 absconds and 6 attempts to abscond). The period prevalence of absconding was 5.5 per 10,000 admissions, and most patients were young, single males, with a high frequency of substance use. Most events took place in the emergency department during the daytime. Discussion: Studying the epidemiological profile of absconding patients and their motivations could facilitate prevention and intervention. Conclusion: A lower absconding rate was found compared to reports from other countries. However, the characteristics of the patients were similar, with a predominance of young, single male patients with psychiatric history.

Keywords: Escape Reaction; Runaway Behavior; Patient Dropouts; Hospitalization.

Resumen

Introducción: Las fugas de pacientes en instituciones de salud se han asociado con desenlaces negativos tanto para los pacientes como las mismas instituciones. A pesar de esto, pocos estudios han evaluado la frecuencia y características de estos eventos en Latinoamérica, especialmente en hospitales generales no especializados en atención psiquiátrica. Objetivo: Describir las características sociodemográficas, clínicas y de los eventos de pacientes que presentaron fuga o intento de fuga en un hospital de alta complejidad de Medellín, Colombia entre 2015 y 2023. Materiales y Métodos: Estudio cuantitativo, descriptivo de corte transversal a partir de fuentes secundarias donde se recolectó la información de historias clínicas de pacientes que presentaron fuga o intento de fuga en el Hospital Alma Mater de Antioquia. Se realizó un análisis estadístico descriptivo de los datos. Resultados: Se presentaron 141 eventos durante el periodo evaluado (135 fugas y 6 intentos de fuga). La prevalencia de periodo de fuga fue 5,5 fugas por cada 10.000 ingresos y la mayoría de los pacientes fueron jóvenes de sexo masculino y solteros, con una alta frecuencia de consumo de tóxicos. La mayoría de los eventos ocurrieron en el servicio de Urgencias durante el día. Discusión: El estudio del perfil epidemiológico de los pacientes fugados podría facilitar su prevención e intervención. Conclusión: Se encontró una tasa de fuga menor a las reportadas en otros países. A pesar de esto, las características de los pacientes fueron similares, predominando un patrón de pacientes masculinos, jóvenes, y solteros con antecedentes psiquiátricos.

Palabras Clave: Reacción de Fuga; Conducta Fugitiva; Pacientes Desistentes del Tratamiento; Hospitalización.

Resumo

Introdução: Fugas de pacientes de instituições de saúde têm sido associadas a desfechos negativos tanto para os pacientes quanto para as próprias instituições. Apesar disso, poucos estudos avaliaram a frequência e as características desses eventos na América Latina, especialmente em hospitais gerais não especializados em atendimento psiquiátrico. Objetivo: Descrever as características sociodemográficas, clínicas e dos eventos de pacientes que sofreram fuga ou tentativa de fuga de um hospital de alta complexidade em Medellín, Colômbia, entre 2015 e 2023. Materiais e Métodos: Foi realizado um estudo quantitativo, descritivo e transversal, utilizando fontes secundárias. As informações foram coletadas dos prontuários médicos de pacientes que sofreram fuga ou tentativa de fuga no Hospital Alma Mater, em Antioquia. Foi realizada uma análise estatística descritiva dos dados. Resultados: Houve 141 eventos durante o período de avaliação (135 fugas e 6 tentativas de fuga). A prevalência de períodos de evasão foi de 5,5 por 10.000 internações, e a maioria dos pacientes era jovem, solteiro, do sexo masculino e frequentemente envolvido no uso de substâncias. A maioria dos eventos ocorreu no Pronto-Socorro durante o dia. Discussão: Estudar o perfil epidemiológico de pacientes em evasão pode facilitar a prevenção e a intervenção. Conclusão: A taxa de evasão foi menor do que a relatada em outros países. Apesar disso, as características dos pacientes foram semelhantes, com predominância de pacientes jovens, solteiros, do sexo masculino e com histórico psiquiátrico.

Palavras-Chave: Reação de Fuga; Comportamento de Esquiva; Pacientes Desistentes do Tratamento; Hospitalização.

 

Introduction

Patient hospitalization is a medical decision made when an individual requires admission to a healthcare institution for a defined period in order to undergo diagnosis or treatment for a health condition. The hospitalization process concludes with hospital discharge, which may occur in various ways, including discharge due to clinical improvement as indicated by the attending physician, transfer to another facility, patient death, self-discharge, or the patient's absence without authorization from healthcare staff, a situation referred to as absconding1,2.

The definition of absconding varies considerably across studies, depending on the specified duration of absence and the institutional policies applied1,3,4. Due to these variations, significant differences in estimates of its frequency are observed. However, the main difference lies in whether the study was conducted in a psychiatric institution or in a general institution that is not specialized in this area. In psychiatric facilities, where most studies have been conducted, reported rates range from 0.2% to 54% of all admissions5, while in non-specialized institutions, rates vary from 0.27% to 2.4%6. With respect to the frequency of attempts to abscond, no specific data have been reported in the literature.

These types of events have been associated with various negative outcomes, most notably a considerable risk of suicide following absconding7, self-inflicted injury, and aggression toward others1. Consequently, they are considered a sentinel event for patient safety. It has also been observed that these patients require longer hospital stays and extended treatment, experience a loss of trust and engagement with healthcare services, and present increased use of psychoactive substances and other risk behaviors after the event1,5. From the institutional perspective, healthcare institutions have reported increased costs of care, risk of harm to other patients, property damages, and disruption of the work environment, all of which negatively impact patient care1.

Despite its relevance, studies on patient absconding and attempts to abscond remain scarce, with most research focusing on psychiatric institutions and overlooking non-specialized institutions where such events also occur6. In Latin America, the available evidence is even more limited, with only two studies conducted in Chile8,9, despite the fact that these phenomena are strongly influenced by contextual and regional factors, which may result in wide variations in frequency. In this context, there is a need to investigate these events in Colombia, particularly in a non-psychiatric institution with a high number of patients. The objective of this study was to describe the sociodemographic and clinical characteristics, as well as the event characteristics, among patients who absconded or attempted to abscond from a tertiary general hospital in Medellín, Colombia, between 2015 and 2023.

 

Materials and Methods

A quantitative, descriptive cross-sectional study was conducted using secondary data sources.

Participants and study setting

Reports of absconding or attempts to abscond from the Alma Mater de Antioquia Hospital (HAMA) main headquarters, in Medellín, Colombia, between January 1, 2015, and August 31, 2023, were selected. During this period, 244,432 patients were admitted, among whom 141 incidents were documented (135 absconds and 6 attempts to abscond). Eligible participants were adults admitted to inpatient or observation services who were reported to have absconded or attempted to abscond during hospitalization. Patients escorted by correctional officers or those who did not authorize the use of personal data were excluded. For the purpose of this study, absconding was defined according to the HAMA institutional protocol as “the patient's departure from the medical care process without authorization, without a discharge form, and without the knowledge of healthcare staff.”3 An attempt to abscond was defined in accordance with the Protocol for Action in the Event of Patient Absconding of the Santiago Metropolitan Hospital as “surprising and stopping the act of a patient's absconding.”4

Procedures

For patient identification, reports of absconding and attempts to abscond during the study period were requested, which have been written according to the institutional protocol since 20153. Each incident was recorded as a separate case if it occurred during a different hospitalization, since each episode had distinct characteristics. If both events occurred during the same hospitalization, only the final event (absconding) was recorded, and the sequence was noted in the study records.

Variables

Medical records were reviewed, and compliance with selection criteria was verified. Relevant sociodemographic variables were extracted (age, sex, marital status, type of residence, educational level, occupation, and type of health insurance). Clinical variables included history of mental disorder, suicide attempts, psychoactive substance use, and prior attempts to abscond during previous hospitalizations. Hospitalization- and event-related variables included patient's main admission diagnosis and the treating specialty, length of stay before the event, time of occurrence, type of hospital room, reports of restlessness, symptoms of craving, use of physical and/or pharmacological restraints, records indicating patient statements of intent to leave, as well as reports of self-inflicted injury, aggression toward others, or property damage during the event.

Bias control

The main bias was measurement bias associated with the study cross-sectional design that relied on secondary sources, as medical records may contain errors or missing information about the patients. To mitigate this, records were thoroughly reviewed, and the data recorded in the medical notes from different professionals (e.g., physicians, nurses) were cross-checked. Participants were selected based on the selection criteria, and all patients meeting these criteria were included.

Statistical analysis

Period prevalence was calculated by using the total number of hospital admissions per year during the study period, using the formula proposed by Molnar et al.10, which divides the number of events by the number of admissions. Descriptive statistics were applied to describe patient characteristics. For qualitative variables, absolute and relative frequencies were reported. For quantitative variables, means and standard deviations or medians and interquartile ranges were calculated, depending on whether the assumption of normality was met. Data were analyzed using R software in the RStudio environment, version 2024.04.1+74811. The dataset is available for free access and consultation in Mendeley Data12.

Ethical considerations

The study protocol was previously reviewed and approved by the HAMA Technical Research Committee (Code IN43-2023, Minutes No. 216) and complies with the principles of the Declaration of Helsinki and Colombian health research regulations.

 

Results

During the study period, 141 events were documented, comprising 135 absconds and 6 attempts to abscond. A prevalence of 5.5 absconds per 10,000 admissions was found, while the annual prevalence varied between 3.5 and 9.1 absconds per 10,000 admissions across the study years. In the case of attempts to abscond, the overall prevalence was 0.26 per 10,000 admissions. The total and annual prevalence of both events are presented in Table 1.

 

Table 1. Annual and total point prevalence of absconding incidents and attempts to abscond in a tertiary general hospital in Medellín, Colombia

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Sociodemographic characteristics

Most patients who absconded were young males, single, and had some level of formal education. Occupation was unknown in the majority of cases, and most patients resided in urban areas, primarily in the municipality of Medellín, with others living in the Aburrá Valley. Patients who attempted to abscond were slightly older and all were male, while their remaining characteristics were similar to those patients who absconded. The complete sociodemographic characteristics are presented in Table 2.

Clinical characteristics

A history of absconding during previous hospitalizations was rare in both patient groups. However, a significant proportion of patients had at least one previously diagnosed mental disorder. While a history of substance use disorder was uncommon, more than half of the patients reported prior substance use (Table 3).

 

Table 2. Sociodemographic characteristics of patients who absconded and attempted to abscond from a tertiary general hospital in Medellín, Colombia. n=141

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Table 2. Sociodemographic characteristics of patients who absconded and attempted to abscond from a tertiary general hospital in Medellín, Colombia. n=141

Characteristics

Absconded

% (n=135)

Attempted to abscond

% (n=6)

Total

% (n=141)
Age in years
    Median (IQR) 36 [27 – 50] 40 [30 – 54] 36 [27 – 50]
    Minimum – Maximum 18 – 85 21 – 63 18 – 85
Sex
    Male 65.90 (89) 100.00 (6) 67.40 (95)
    Female 34.10 (46) 0.00 (0) 32.60 (46)
Marital status
    Single 68.80 (93) 50.00 (3) 68.10 (96)
    Cohabiting 15.60 (21) 0.00 (0) 14.90 (21)
    Married 11.90 (16) 16.70 (1) 12.10 (17)
    Divorced 1.50 (2) 16.70 (1) 2.10 (3)
    Unknown 2.20 (3) 16.70 (1) 2.80 (4)
Educational level
    No formal education 8.10 (11) 0.00 (0) 7.80 (11)
    Elementary 34.10 (46) 16.70 (1) 33.30 (47)
    High school 28.90 (39) 50.00 (3) 29.80 (42)
    Higher education 13.30 (18) 33.30 (82) 14.20 (20)
    Unknown 15.50 (21) 0.00 (0) 14.90 (21)
Occupation
    Homemaker 16.30 (22) 0.00 (0) 15.60 (22)
    Unemployed 12.60 (17) 33.30 (2) 13.50 (19)
    No occupation 8.20 (11) 0.00 (0) 7.80 (11)
    Retired 5.20 (7) 0.00 (0) 5.00 (7)
    Homeless 3.70 (5) 0.00 (0) 3.50 (5)
    Other 24.40 (33) 33.30 (2) 24.80 (35)
    Unknown 29.60 (40) 33.30 (2) 29.80 (42)
Type of residence
    Urban 89.70 (121) 100 (6) 90.10 (127)
    Rural 4.40 (6) 0.00 (0) 4.30 (6)
    Unknown 5.90 (8) 0.00 (0) 5.60 (8)
Health insurance
    Subsidized 54.10 (73) 33.30 (2) 53.20 (75)
    Contributory 40.00 (54) 33.30 (2) 39.70 (56)
    Special 5.90 (8) 33.30 (2) 7.10 (10)

Abbreviations: IQR = Interquartile range

 

Table 3. Clinical characteristics of patients who absconded or attempted to abscond from a tertiary general hospital in Medellín, Colombia. n=141

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Table 3. Clinical characteristics of patients who absconded or attempted to abscond from a tertiary general hospital in Medellín, Colombia. n=141

Characteristic

Absconded

% (n=135)

Attempted to abscond

% (n=6)

Total

% (n=141)
History of absconding during previous hospitalizations
    Absent 94.80 (128) 83.30 (5) 94.30 (133)
    Present 5.20 (7) 16.70 (1) 5.70 (8)
History of mental disorder
    No 60.70 (82) 33.30 (2) 59.60 (84)
    Yes 39.30 (53) 66.70 (4) 40.40 (57)
Previous diagnosis of mental disorder*
    Bipolar disorder 20.00 (27) 0.00 (0) 19.20 (27)
    Substance-related disorders 11.10 (15) 16.60 (1) 11.30 (16)
    Schizophrenia 5.90 (8) 16.60 (1) 6.40 (9)
    Depressive disorder 4.40 (6) 16.60 (1) 5.00 (7)
    Anxiety disorder 2.90 (4) 16.60 (1) 3.50 (5)
    Personality disorder 2.90 (4) 16.60 (1) 3.50 (5)
    Other mental disorders 1.50 (2) 33.30 (2) 2.80 (4)
History of suicide attempts
    No 81.50 (110) 66.70 (4) 80.90 (114)
    Yes 17.00 (23) 33.30 (2) 17.70 (25)
    Unknown 1.50 (2) 0.00 (0) 1.40 (2)
History of toxic substance use
    No 40.70 (55) 16.60 (1) 39.70 (56)
    Yes 57.10 (77) 83.40 (5) 58.20 (82)
    Unknown 2.20 (3) 0.00 (0) 2.10 (3)
Type of toxic substance used*
    Marijuana 35.50 (48) 50.00 (3) 36.20 (51)
    Cocaine and derivatives 35.50 (48) 33.30 (2) 35.50 (50)
    Tobacco 29.60 (40) 33.30 (2) 29.80 (42)
    Alcohol 21.50 (29) 33.30 (2) 21.90 (31)
    Heroin 16.30 (22) 0.00 (0) 15.60 (22)
    Benzodiazepines 4.40 (6) 0.00 (0) 4.30 (6)
    Inhalants 3.70 (5) 0.00 (0) 3.50 (5)
    Other stimulants 1.50 (2) 0.00 (0) 1.40 (2)

* Not mutually exclusive

 

Event characteristics

Most events occurred during the first days of hospitalization, primarily in the emergency department (Table 4). The majority of absconding incidents took place during the day shift, particularly in the late afternoon, with a peak between 5:00 pm and 7:00 pm. In contrast, most attempts to abscond occurred during the night shift. Reports of restlessness during hospitalization were relatively uncommon, as were reports of the need for physical or pharmacological restraint or the presence of symptoms of craving. Self-inflicted injury and aggression toward others were reported in only one case of attempted absconding, and no instances of property damage were documented.

 

Table 4. Characteristics of absconding events or attempts to abscond from a tertiary general hospital in Medellín, Colombia. n=141

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Table 4. Characteristics of absconding events or attempts to abscond from a tertiary general hospital in Medellín, Colombia. n=141

Characteristic

Absconded

% (n=135)

Attempted to abscond

% (n=6)

Total

% (n=141)
Days of hospital stay until the event
    Median (IQR) 2 [1 – 4] 5.5 [2 – 6] 2 [1 – 5]
    Minimum – Maximum 0 – 94 1 – 7 0 – 94
Shift during which the event occurred
    Day (7 am – 7 pm) 68.10 (92) 33.30 (2) 66.70 (94)
    Night (7 pm – 7 am) 31.90 (43) 66.70 (4) 33.30 (47)
Service where the event occurred
    Emergency 59.30 (80) 66.70 (4) 59.60 (84)
    General inpatient service 40.70 (55) 33.30 (2) 40.40 (57)
    ICU/SCU 0.00 (0) 0.00 (0) 0.00 (0)
Admissions diagnosis
   Mental and behavioral disorders 28.90 (39) 16.60 (1) 28.40 (40)
   Trauma, poisoning, and other consequences of external causes 22.90 (31) 0.00 (0) 22.00 (31)
    Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified 11.90 (16) 50.00 (3) 13.50 (19)
    Circulatory system diseases 5.90 (8) 0.00 (0) 5.70 (8)
    Respiratory system diseases 5.90 (8) 0.00 (0) 5.70 (8)
   Digestive system diseases 4.40 (6) 16.60 (1) 4.90 (7)
   Infectious and parasitic diseases 3.70 (5) 0.00 (0) 3.50 (5)
   Other 16.30 (22) 16.60 (1) 16.30 (23)
Treating specialty
    General medicine 25.20 (34) 0.00 (0) 24.10 (34)
    Internal medicine 20.70 (28) 33.30 (2) 21.30 (30)
    Psychiatry 19.30 (26) 33.30 (2) 19.90 (28)
    General surgery 8.10 (11) 16.60 (1) 8.50 (12)
    Orthopedics 7.40 (10) 16.60 (1) 7.80 (11)
    Plastic surgery 3.70 (5) 0.00 (0) 3.50 (5)
    Other 15.60 (21) 0.00 (0) 14.90 (21)
Restlessness during hospitalization
    No 77.10 (104) 50.00 (3) 75.90 (107)
    Yes 22.90 (31) 50.00 (3) 24.10 (34)
Need for pharmacological restraint
    No 78.50 (106) 50.00 (3) 77.30 (109)
    Yes 21.50 (29) 50.00 (3) 22.70 (32)
Requirement for physical restraint
    No 87.40 (118) 50.00 (3) 85.80 (121)
    Yes 12.60 (17) 50.00 (3) 14.20 (20)
Craving during hospitalization
    No 88.90 (120) 66.60 (4) 87.90 (124)
    Yes 11.10 (15) 33.30 (2) 12.10 (17)
Prior statements of intent to leave
    No 72.60 (98) 50.00 (3) 71.60 (101)
    Yes 27.40 (37) 50.00 (3) 28.40 (40)

Abbreviations: ICU=Intensive Care Unit. SCU=Special Care Unit. IQR= Interquartile range

 

Patients diagnosed with mental and behavioral disorders upon admission

Considering the differences in the frequency of events between psychiatric and non-psychiatric hospitals, a comparison was made between patients with and without a diagnosis of mental and behavioral disorders at the time of admission (Table 5). Although some characteristics of both groups were similar, patients who did have a diagnosis were younger, and few had a history of mental disorder. Similarly, they exhibited greater restlessness during hospitalization and required pharmacological and physical restraints.

 

Table 5. Characteristics of patients who experienced events according to the presence of a diagnosis of mental and behavioral disorders upon admission. n=141

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Table 5. Characteristics of patients who experienced events according to the presence of a diagnosis of mental and behavioral disorders upon admission. n=141

Characteristic Diagnosis of mental and behavioral disorder at admission

Total

% (n=141)
Yes % (n=40) No % (n=101)
Age in years
    Median (IQR) 32 [27 – 40] 38 [27 – 54] 36 [27 – 50]
    Minimum – Maximum 18–63 18–85 18 – 85
History of mental disorder
    No 80.00 (32) 24.80 (25) 59.60 (84)
    Yes 20.00 (8) 75.20 (76) 40.40 (57)
History of toxic substance use
    No 35.00 (14) 41.60 (42) 39.70 (56)
    Yes 65.00 (26) 55.40 (56) 58.20 (82)
    Unknown 0.00 (0) 3.00 (3) 2.10 (3)
Restlessness during hospitalization
    No 52.50 (21) 85.10 (86) 75.90 (107)
    Yes 47.50 (19) 14.90 (15) 24.10 (34)
Need for pharmacological restraint
    No 52.50 (21) 87.10 (88) 77.30 (109)
    Yes 47.50 (19) 12.90 (13) 22.70 (32)
Requirement for physical restraint
    No 70.00 (28) 92.10 (93) 85.80 (121)
    Yes 30.00 (12) 7.90 (8) 14.20 (20)
Craving during hospitalization
    No 92.50 (37) 86.10 (87) 87.90 (124)
    Yes 7.50 (3) 13.90 (14) 12.10 (17)
Service where the event occurred
    Emergency 97.50 (39) 45.60 (45) 59.60 (84)
    General inpatient service 2.50 (1) 55.40 (56) 40.40 (57)

Abbreviations: IQR = Interquartile range

 

 

Discussion

This study analyzed events of absconding and attempts to abscond from a tertiary general hospital in Medellín, Colombia, over a nine-year period and found a prevalence of 5.5 absconds and 0.26 attempts to abscond per 10,000 admissions. Most cases involved men in their forties, who were single and had an elementary or high school education. The prevalence observed in this study may be considered low compared with that reported in other non-psychiatric institutions: Iglesis et al.9 in Chile (0.4%), Anisi et al.6 in Iran (0.4%), Khammarnia et al.13 in Iran (0.5%), and Cheng et al.14 in Hong Kong (0.27%). Some authors suggested different reasons for these differences across contexts, highlighting the characteristics of health systems as a constant explanation for many of the causes of absconding15. It has been found that the inability to pay medical expenses and lack of insurance coverage are associated with vulnerable or migrant populations who abscond. Although the majority of patients included in this study had an unknown occupation, a low percentage of unemployed and homeless individuals were observed, in contrast to findings from other studies13. Furthermore, in this study, due to the provisions of the Colombian healthcare system, all patients had health insurance. In contrast, in other studies, the percentage of people without health insurance was over 50% in the groups of absconders6,13.

Other reasons that may contribute to absconding include the absence of standardized protocols and a lack of specific training for healthcare personnel in managing such situations15. Although the authors of the studies do not explicitly mention the existence of surveillance protocols in the hospitals examined, healthcare personnel have reported the need for clear and well-defined care guidelines to manage these events and mitigate their impact on patients and their environment15. Different institutional surveillance protocols, and even the lack of protocols in other contexts, may explain the differences in the frequency of events across studies, since absconding may be defined and managed differently across services, making comparisons difficult16.

In relation to patient characteristics, it was observed that absconders were predominantly young, male, and single, similar to findings in Chile by Valdivieso et al.8, and consistent with results from both psychiatric and non-psychiatric hospitals in different countries14,17,18. A history of substance use, reported in more than half of the study population, has also been identified as a risk factor for absconding in previous studies6,18. Yahyavi et al.17 reported bipolar affective disorder and substance use disorder as the most prevalent psychiatric diagnoses in their population, consistent with this study. In contrast, other research has identified schizophrenia as the predominant diagnosis19. Likewise, comparable lengths of stay prior to the event have been reported, with mental disorders frequently observed as the primary diagnosis and general medicine the most common treating specialty, both in general and psychiatric hospitals14.

Comparison of patients with and without a diagnosis of mental and behavioral disorders at admission revealed largely similar characteristics between the groups. However, a prior history of mental disorder was less frequent in the group diagnosed upon admission. This could be explained by the tendency for patients with an established history of mental illness who experience decompensation to be taken directly by relatives to specialized psychiatric centers. In contrast, those experiencing these symptoms for the first time are initially treated in general hospitals. As expected, patients diagnosed with mental and behavioral disorders exhibited greater restlessness and required more frequent use of pharmacological and physical restraints. Although craving was infrequently observed despite high rates of substance use, this may be explained by the anxiolytic effects of medications administered for restraint. Moreover, most of these patients were treated in the emergency department during initial acute management and/or pending transfer to mental health units, explaining why almost all events occur in this setting. This comparison by diagnostic category has not been performed in other studies in general hospitals, and it remains unclear whether similar patterns would be observed elsewhere.

Regarding the motivations behind absconding, Martin et al.20 proposed four categories to classify them. Absconding may be goal-oriented, such as the desire to use substances, significant life events, the need to protect other people or belongings, or the urgency to achieve or locate something specific. Given the high frequency of substance use in this study, it is possible that this was an important motivation in the cases observed. The presence of craving also raises the question of whether it would be necessary to implement intensive management of this symptom during the hospitalization of these patients.

Absconding may be associated with frustration with healthcare. This frustration may arise due to dissatisfaction with treatment regimens, physicians, staff, or length of hospital stay, as well as feelings of boredom, confinement, or fear. In this study, the length of stay was relatively short among patients; however, this concern could be addressed by providing a clear description of expected timelines, which would help reduce the uncertainty experienced by patients21. Symptomatic motivations for absconding generally involve patients who abscond due to episodes of psychosis or cognitive impairment20. In some of the cases studied, this could be related to diagnoses of schizophrenia, although no patients with formally diagnosed cognitive impairment who may have this motivation were found. Despite this, the possibility that other disorders or conditions leading to intense emotions, such as paranoia or fear, may have influenced the patients' decision to abscond cannot be completely ruled out. Finally, in some cases, absconding may occur due to the patient's impulsivity or the emergence of an opportunity, such as an unlocked door or window20. It is possible that the times when the highest number of absconds were observed, especially towards the end of the afternoon, are times when these events are more likely to occur. However, it should be noted that opportunities for absconding at the hospital where the study was conducted are limited by its infrastructure and the security measures implemented by the company responsible for the institution's security.

In other contexts, qualitative studies have been conducted to explore the motivations behind absconding in general hospitals15. Supplementing quantitative data with qualitative approaches would provide a more comprehensive understanding of the factors influencing these events, exploring patients' experiences and perceptions, as well as the barriers or facilitators perceived by healthcare staff. Furthermore, the use of mixed methods could offer a more detailed perspective, helping to identify patterns and design effective interventions. These approaches would not only allow the quantification of the prevalence of absconding but also enable the clarification of its underlying reasons and the development of prevention strategies more appropriate to hospital contexts.

Some strategies proposed in the literature to prevent absconding and attempts to abscond focus on improving communication between healthcare personnel and patients. Establishing closer relationships with patients and understanding their preferences and frustrations regarding hospitalization can facilitate person-centered care, which would help reduce potential conflicts and patients' disposition to abscond15. Providing clear and specific information about patients' health status and its practical implications may also reduce confusion and prevent absconding or attempts to abscond. There are non-restrictive interventions, such as the Safewards model22, which includes a set of simple interventions designed to make hospital units more person-centered. This model has been adopted and successfully evaluated in psychiatric hospitals worldwide23. Additional strategies to minimize harm and reduce the incidence of absconding include shared decision-making, close patient monitoring, careful communication of bad news to prevent conflict, and the use of assertive language to reframe potential areas of tension. Reducing the risk of absconding and harm to patients while they are hospitalized requires the implementation of a comprehensive approach that involves not only healthcare staff but also caregivers, family members, and patients themselves.

Other authors have suggested introducing structured activities to reduce boredom and frustration24 and adopting a recovery-oriented approach to promote less restrictive hospital environments, thereby reducing the incidence of absconding24,25. Identifying the characteristics of patients who abscond or attempt to abscond can not only improve prevention but also enable more active monitoring and the implementation of personalized alerts, which in turn could reduce the risk of complications and improve clinical outcomes. In this context, risk assessment tools such as absconding risk scales and risk profile identification could be highly valuable for conducting structured assessments of patients admitted and promoting prevention and surveillance strategies26-28.

Regarding attempts to abscond, during the review of medical records throughout the research, references to these events were identified in patients who did not have an official report of absconding attempts, suggesting that there may be significant underreporting of such incidents. This can be explained by the lack of explicit mention of such events in HAMA's institutional protocols3, indicating that a greater awareness of the characteristics of this event may be necessary. Nevertheless, the results regarding these patients remain relevant, as very few studies in the literature have specifically addressed this event29,30. A detailed study of their characteristics and associated motivations could play a key role in preventing absconding. One strategy to consider is designing research projects that use qualitative approaches to understand or explore the motivations of these patients. For example, techniques such as interviews allow for a deeper understanding of patients' direct experiences and motivations, as well as the economic, social, and psychological factors that influence their decision to abscond, something that clinical and sociodemographic data cannot always capture.

The limitations of this study include its descriptive design and the low number of reported attempts to abscond, which prevented making comparisons to identify differences between groups. The retrospective review of medical records limited the analysis to information that had been documented, leaving out unrecorded details. Likewise, due to the lack of information on the characteristics of all hospital admissions, it was not possible to calculate differential prevalence values according to specific variables, such as patients with and without a diagnosis of mental and behavioral disorders at admission. Nevertheless, to the best of our knowledge, this is the first study in Colombia to evaluate absconding and attempts to abscond among patients in general hospitals. It provides important groundwork for the development of new research aimed at identifying risk factors for absconding and attempts to abscond and proposing effective prevention strategies.

 

Conclusion

A low prevalence of absconding was found compared with rates reported in the literature. Nevertheless, the characteristics of absconding patients were similar to those described in other countries, in both psychiatric and non-psychiatric hospitals, with most being young, male, and single. While a higher proportion of patients had a history of substance use, fewer had a history of mental disorder or were admitted with such a diagnosis. Identifying these characteristics may support the development of risk profiles for in-hospital surveillance and facilitate the prevention and management of these events.

Conflict of Interest: The authors declare no conflict of interest related to this study.

Funding: This research and the preparation of the article received no financial support from any funding agency.

 

References

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Anisi S, Zarei E, Kariman H, Kazemi MK, Chehrazi M. Patient Absconding and Its Predictors: A 5-Year Retrospective Analysis in a General Teaching Hospital in Tehran, Iran. Shiraz E-Med J. 2017;18(12):e14532. https://doi.org/10.5812/semj.14532

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Moradpour M, Amiresmaili M, Nekoei-Moghadam M, Dehesh Tania. The reasons why patients abscond from public hospitals in southeastern Iran: a qualitative study. Arch Public Health. 2021;79(1):106. https://doi.org/10.1186/s13690-021-00634-z

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Atienza Martinez A, Font Pujol J, Buxó Pujolràs M, Turró Garriga O. Conociendo al paciente con riesgo de fuga. Rev Enferm Salud Ment. 2017;5–14. https://doi.org/10.5538/2385-703X.2017.8.5

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Martin K, McGeown M, Whitehouse M, Stanyon W. Who’s going to leave? An examination of absconding events by forensic inpatients in a psychiatric hospital. J Forensic Psychiatry Psychol. 2018;29(5):810–823. https://doi.org/10.1080/14789949.2018.1467948

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Handel DA, Fu R, Daya M, York J, Larson E, John McConnell K. The Use of Scripting at Triage and Its Impact on Elopements. Acad Emerg Med. 2010;17(5):495–500. https://doi.org/10.1111/j.1553-2712.2010.00721.x

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Referencias

Bowers L. Safewards: a new model of conflict and containment on psychiatric wards. J Psychiatr Ment Health Nurs. 2014;21(6):499–508. https://doi.org/10.1111/jpm.12129

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Fletcher J, Reece J, Kinner SA, Brophy L, Hamilton B. Safewards Training in Victoria, Australia: A Descriptive Analysis of Two Training Methods and Subsequent Implementation. J Psychosoc Nurs Ment Health Serv. 2020;58(12):32–42. https://doi.org/10.3928/02793695-20201013-08

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Marlett JE, Vacovsky BA, Krug EA, Ha‐Johnson TM, Hill SAF. Elopement: Evidence‐based mitigation and management. Worldviews Evid Based Nurs. 2023;20(6):634–641. https://doi.org/10.1111/wvn.12683

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Booth BD, Michel SF, Baglole JS, Healey LV, Robertson HV. Validation of the Booth Evaluation of Absconding Tool for Assessment of Absconding Risk. J Am Acad Psychiatry Law. 2021;49(3):338–349. https://europepmc.org/article/med/34001671

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Brumbles D, Meister A. Psychiatric elopement: using evidence to examine causative factors and preventative measures. Arch Psychiatr Nurs. 2013;27(1):3–9. https://doi.org/10.1016/J.APNU.2012.07.002

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Wilkie T, Penney SR, Fernane S, Simpson AIF. Characteristics and motivations of absconders from forensic mental health services: a case-control study. BMC Psychiatry. 2014;14(1):91. https://doi.org/10.1186/1471-244X-14-91

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Tommasini NR, Iennaco JD. A Model Program to Manage Behavioral Emergencies and Support Nurses in the Medical Setting. Nurs Adm Q. 2022;46(1):37–44. https://doi.org/10.1097/NAQ.0000000000000501

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  1. Muir-Cochrane E, Mosel KA. Absconding: A review of the literature 1996–2008. Int J Ment Health Nurs. 2008;17(5):370–378. https://doi.org/10.1111/j.1447-0349.2008.00562.x

  2. Yugero Torres O, Pérez Pérez RM. El alta voluntaria y la fuga en los servicios de urgencias: un reto con implicaciones éticas y médico-legales. Emergencias. 2018;30:433–436. https://revistaemergencias.org/numeros-anteriores/volumen-30/numero-6/el-alta-voluntaria-y-la-fuga-en-los-servicios-de-urgencias-un-reto-con-implicaciones-eticas-y-medico-legales/

  3. Hospital Alma Máter. Procedimientos de vigilancia y seguridad física Hospital Alma Máter de Antioquia. Medellín: Hospital Alma Máter de Antioquia; 2024. Consulta: Julio 17, 2024. Disponible en: https://calipsuvisor.ghips.co//FileViewer/VerArchivoPdfJs?fileName=PC-LG-0794%20%20%20PROCEDIMIENTO%20VIGILANCIA%20Y%20SEGURIDAD%20FISICA%20V13.pdf

  4. Hospital Metropolitano de Santiago. Protocolo de acción frente a fuga de pacientes. Santiago de Chile: Hospital Metropolitano de Santiago; 2010. Consulta: Julio 17, 2024. Disponible en: https://sb86eb09335ad47f5.jimcontent.com/download/version/1325778618/module/3697993752/name/Hospital%20Santiago%20de%20Chile%202010%20-Protocolo%20Fuga-.pdf

  5. Olagunju AT, Bouskill SL, Olagunju TO, Prat SS, Mamak M, Chaimowitz GA. Absconsion in forensic psychiatric services: a systematic review of literature. CNS Spectr. 2022;27(1):46–57. https://doi.org/10.1017/S1092852920001881

  6. Anisi S, Zarei E, Kariman H, Kazemi MK, Chehrazi M. Patient Absconding and Its Predictors: A 5-Year Retrospective Analysis in a General Teaching Hospital in Tehran, Iran. Shiraz E-Med J. 2017;18(12):e14532. https://doi.org/10.5812/semj.14532

  7. Bowers L, Banda T, Nijman H. Suicide inside: a systematic review of inpatient suicides. J Nerv Ment Dis. 2010;198(5):315–328. https://doi.org/10.1097/nmd.0b013e3181da47e2

  8. Valdivieso FS, Olivos P, Concha F, et al. Estudio descriptivo de los episodios de fuga en el Hospital Psiquiatrico de Santiago. Rev Psiquiatría. 1989;6(4):281–295. https://schilesaludmental.cl/web/wp-content/uploads/2022/10/89-4-005-Estudio-descriptivo-de-los-episodios-de-fuga-en-el-Hospital-Psiquia%CC%81trico-de-Santiago..pdf

  9. Iglesis Honorato I, Alvarado Alvarez N, Wosiack Menin A, Silva Figueroa M, Escobar Montoya A, Bravo Lazaneo E. Frecuencia de fugas de pacientes en el servicio de urgencia en el Hospital Comunitario de Til Til entre agosto 2016 y agosto 2017. V Congreso de Estudiantes de Medicina de Maule; 2017 Nov 9-11; Talca, Chile. Consulta: Julio 17, 2024. Disponible en: https://portal.ucm.cl/content/uploads/2017/12/Resumen_V_CEMM_2017.pdf

  10. Molnar G, Pinchoff DM. Factors in patient elopements from an urban state hospital and strategies for prevention. Hosp Community Psychiatry. 1993;44(8):791–792. https://doi.org/10.1176/ps.44.8.791

  11. RStudio Team. RStudio: Integrated Development for R. [Internet] 2015 [Cited 2024 Sept 8]. Available from: http://www.rstudio.com/

  12. Prada Aceros NJ, Castrillon-Martinez E, Perez-Gutierrez AM, Zapata-Ospina JP. Características sociodemográficas y clínicas de pacientes que presentaron fuga o intento de fuga en el HAMA. 2024. Mendeley Data: Versión 1. https://doi.org/10.17632/jhw2pzxc7h.1

  13. Khammarnia M, Kassani A, Amiresmaili MR, Sadeghi A, Karimi Jaberi Z, Kavosi Z. Study of patients absconding behavior in a general hospital at southern region of Iran. Int J Health Policy Manag. 2015;4(3):137–141. https://doi.org/10.15171/ijhpm.2014.110

  14. Cheng ST, Chung CH, Leung YH, Lai KK. Patient absconding behaviour in a public general hospital: retrospective study. Hong Kong Med J. 2002;8(2):87–91. https://www.hkmj.org/abstracts/v8n2/87.htm

  15. Moradpour M, Amiresmaili M, Nekoei-Moghadam M, Dehesh Tania. The reasons why patients abscond from public hospitals in southeastern Iran: a qualitative study. Arch Public Health. 2021;79(1):106. https://doi.org/10.1186/s13690-021-00634-z

  16. Muir-Cochrane E, Muller A, Oster C. Absconding: A qualitative perspective of patients leaving inpatient psychiatric care. Int J Ment Health Nurs. 2021;30(5):1127–1135. https://doi.org/10.1111/inm.12863

  17. Yahyavi ST, Faraji S. Absconding from a Psychiatric Hospital in a Developing Country, Related Factors, and the Consequences. Med J Islam Repub Iran. 2023;37(1):865-869. https://doi.org/10.47176/mjiri.37.110

  18. Atienza Martinez A, Font Pujol J, Buxó Pujolràs M, Turró Garriga O. Conociendo al paciente con riesgo de fuga. Rev Enferm Salud Ment. 2017;5–14. https://doi.org/10.5538/2385-703X.2017.8.5

  19. Gerace A, Oster C, Mosel K, O’Kane D, Ash D, Muir-Cochrane E. Five-year review of absconding in three acute psychiatric inpatient wards in Australia. Int J Ment Health Nurs. 2015;24(1):28–37. https://doi.org/10.1111/inm.12100

  20. Martin K, McGeown M, Whitehouse M, Stanyon W. Who’s going to leave? An examination of absconding events by forensic inpatients in a psychiatric hospital. J Forensic Psychiatry Psychol. 2018;29(5):810–823. https://doi.org/10.1080/14789949.2018.1467948

  21. Handel DA, Fu R, Daya M, York J, Larson E, John McConnell K. The Use of Scripting at Triage and Its Impact on Elopements. Acad Emerg Med. 2010;17(5):495–500. https://doi.org/10.1111/j.1553-2712.2010.00721.x

  22. Bowers L. Safewards: a new model of conflict and containment on psychiatric wards. J Psychiatr Ment Health Nurs. 2014;21(6):499–508. https://doi.org/10.1111/jpm.12129

  23. Fletcher J, Reece J, Kinner SA, Brophy L, Hamilton B. Safewards Training in Victoria, Australia: A Descriptive Analysis of Two Training Methods and Subsequent Implementation. J Psychosoc Nurs Ment Health Serv. 2020;58(12):32–42. https://doi.org/10.3928/02793695-20201013-08

  24. Fletcher J, Hamilton B, Kinner S, Sutherland G, King K, Tellez JJ, et al. Working towards least restrictive environments in acute mental health wards in the context of locked door policy and practice. Int J Ment Health Nurs. 2019;28(2):538–550. https://doi.org/10.1111/inm.12559

  25. McKenna B, Furness T, Dhital D, Ennis G, Houghton J, Lupson C, et al. Recovery-Oriented Care in Acute Inpatient Mental Health Settings: An Exploratory Study. Issues Ment Health Nurs. 2014;35(7):526–532. https://doi.org/10.3109/01612840.2014.890684

  26. Marlett JE, Vacovsky BA, Krug EA, Ha‐Johnson TM, Hill SAF. Elopement: Evidence‐based mitigation and management. Worldviews Evid Based Nurs. 2023;20(6):634–641. https://doi.org/10.1111/wvn.12683

  27. Booth BD, Michel SF, Baglole JS, Healey LV, Robertson HV. Validation of the Booth Evaluation of Absconding Tool for Assessment of Absconding Risk. J Am Acad Psychiatry Law. 2021;49(3):338–349. https://europepmc.org/article/med/34001671

  28. Brumbles D, Meister A. Psychiatric elopement: using evidence to examine causative factors and preventative measures. Arch Psychiatr Nurs. 2013;27(1):3–9. https://doi.org/10.1016/J.APNU.2012.07.002

  29. Wilkie T, Penney SR, Fernane S, Simpson AIF. Characteristics and motivations of absconders from forensic mental health services: a case-control study. BMC Psychiatry. 2014;14(1):91. https://doi.org/10.1186/1471-244X-14-91

  30. Tommasini NR, Iennaco JD. A Model Program to Manage Behavioral Emergencies and Support Nurses in the Medical Setting. Nurs Adm Q. 2022;46(1):37–44. https://doi.org/10.1097/NAQ.0000000000000501