Consenting Operative Orthopaedic Trauma Patients: Challenges and Solutions

Abstract

Guidelines exist to obtain informed consent before any operative procedure. We completed an audit cycle starting with retrospective review of 50 orthopaedic trauma procedures (Phase 1 over three months to determine the quality of consenting documentation). The results were conveyed and adequate training of the staff was arranged according to guidelines from BOA, DoH, and GMC. Compliance in filling consent forms was then prospectively assessed on 50 consecutive trauma surgeries over further three months (Phase 2). Use of abbreviations was significantly reduced (P = 0.03) in Phase 2 (none) compared to 10 (20%) in Phase 1 with odds ratio of 0.04. Initially, allocation of patient's copy was dispensed in three (6% in Phase 1) cases compared to 100% in Phase 2, when appropriate. Senior doctors (registrars or consultant) filled most consent forms. However, 7 (14%) consent forms in Phase 1 and eleven (22%) in Phase 2 were signed by Core Surgical Trainees year 2, which reflects the difference in seniority amongst junior doctors. The requirement for blood transfusion was addressed in 40% of cases where relevant and 100% cases in Phase 2. Consenting patients for trauma surgery improved in Phase 2. Regular audit is essential to maintain expected national standards.

How to effectively obtain informed consent in trauma patients: a systematic review

“…Hence, patients’ needs may not be properly met by current principles of consent to treatment, particularly in emergency circumstances. One study recommended that a specific training program on obtaining consent for common orthopedic trauma procedures should be developed for junior doctors [57]. Moreover, if a patient refuses a life-saving procedure in an emergency situation, junior residents may lack the confidence to handle the ethical dilemma [58].…”

An audit of consenting practices in a district general hospital. Can we improve?

“…Jeyaseelan L. et al (8), have reported use of abbreviations in 42.3% of consent forms with incomplete details and only 35.2% of patients were given a copy, they concluded that minor changes in consenting methods and more precise documentation could significantly improve patient experience and satisfaction. Use of abbreviations in consent forms were also reported by Sinha S. et al and Kheiran A. et al (7,9). Kheiran A. et al, also reported that the use of abbreviations was significantly reduced (P=0.03) with odds ratio of 0.04 after adequate training of staff, they recommended specific training sessions for junior doctors during induction on consenting common trauma procedures, and that regular audit is essential to maintain expected national standards.…”

Poor compliance documenting informed consent in trauma patients with distal radius fractures compared to elective total knee arthroplasty

“…It is likely that the high usage of junior registrars to complete the written consenting process contributed to the poor documentation of the informed consent process. Previous studies have demonstrated registrars, or residents, may not have sufficient clinical experience to anticipate potential surgical complications and risks or have adequate communication skills to explain the information in adequate detail 45–47 . The consenting surgeon should be aware of all the potential complications and their appropriate management.…”