Written Consent – A Prospective Audit of Practices for ENT Patients

Abstract

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

Effectiveness of consenting in Otorhinolaryngology

“…This is comparable with the study done by Berry et al in which they got almost 15% of their candidates signing the consent form on the same day. In that study, they reduced this to 2% by introducing a simple policy in their department which prevented patients from progressing from the pre-operative assessment clinic if the consent form had not been filled [18]. A small percentage of patients (4%) signed the forms a year or more before surgery.…”

Evaluación del consentimiento informado en los hospitales públicos españoles: estandarización, calidad, accesibilidad y legibilidad.

“…Factores que pueden conducir a la obtención de un consentimiento "no válido" −desde un punto de vista ético o legal− y en ocasiones, sin embargo, aceptados como "válidos" en la práctica asistencial. Algunas de estas incoherencias abarcan aspectos como: ofrecer la información en términos técnicos e incomprensibles para la persona atendida 119 , no respectar que el paciente disponga de suficiente tiempo para reflexionar sobre su decisión en salud 120 , concebir el documento de consentimiento informado como un "puro formalismo burocrático" y por ende, exigir al paciente que lo firme tan sólo unas horas previas a la cirugía en cuyas circunstancias puede sentirse bajo presión o inducido a la aceptación de dicho procedimiento 121 .…”

“…De hecho, las recomendaciones y guías de práctica clínica advierten que el consentimiento de anestesia y transfusión sanguínea obtenido en la sala prequirúrgica (antequirófano) se considera inválido debido a que el individuo se encuentra en situación de especial vulnerabilidad, primando la ansiedad, el estrés quirúrgico y las presiones psicológicas personales, familiares e incluso, por parte del equipo asistencial, y por ende, viéndose comprometida su capacidad para tomar decisiones autónomas 268 . A pesar de ello, los estudios científicos revelan que aún se continúa realizando una mala praxis al respecto 120,121,132 .…”