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Ann R Coll Surg Engl 2008; 90: 150-152 150Recently, there has been a number of medicolegal cases in which the plaintiffs have argued that they were not given sufficient time to consider the consequences of procedures that they had just consented to have performed. The case of Chester vs Afshar, amongst others, has popularised the importance of giving patients sufficient time to consider carefully the full implications of their proposed surgery. 1 We have noticed that, in our ENT department, a proportion of patients are consented for their surgery on the same day as their surgery. In the event of an unfavourable surgical outcome, this practice may well substantiate the patients' case for compensation.The aims of this study were to: (i) audit the number and types of patients that are being consented for surgery on the same day as their operations; (ii) introduce a mechanism to prevent this practice; and (iii) re-audit the number and types of patients that are being consented for surgery on the same day as their operations. The gold standard would be to ensure that all patients have been consented for their surgery prior to the day of surgery. Patients and MethodsThis was a blinded prospective audit of patients without a valid consent form on the day of surgery. The information was gathered by an ENT senior house officer (SHO) who was not involved with the consenting procedure. The rest of the departmental staff comprising 3 consultants, 3 registrars, 2 staff grades, 2 research fellows and an SHO remained unaware of the fact that the audit was taking place. Upon commencing the audit, the standard practice was for the patients to be consented in clinic at the time of listing for the operation and then to be seen in a preassessment clinic 1 week prior to surgery.One-hundred, consecutive, patient case-notes were reviewed on the morning of surgery to determine whether consent prior to arrival for their elective operation had been obtained. Patients admitted for emergency operations were excluded from the audit. If consent was lacking, then a reason for the absence of consent was sought and noted solely from information available in the case notes.The results were analysed and a new policy was introduced so that patients would not be able to progress from the pre-operative assessment clinic without a valid consent form being completed. This was initiated across adult and paediatric nurse-led pre-assessment clinics; if a consent form was not satisfactorily completed, the nurse running the clinic would contact an appropriate doctor to consent the patient at that time. Patients not attending a preassessment clinic for routine surgery had their operations

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