An audit of consent for allograft use in elective orthopaedic surgery

Abstract

Introduction Patients receiving musculoskeletal allografts may be at risk of postoperative infection. The General Medical Council guidelines on consent highlight the importance of providing patients with the information they want or need on any proposed investigation or treatment, including any potential adverse outcomes. With the increased cost of defending medicolegal claims, it is paramount that adequate, clear informed patient consent be documented. Methods We retrospectively examined the patterns of informed consent for allograft bone use during elective orthopaedic procedures in a large unit with an onsite bone bank. The initial audit included patients operated over the course of 1 year. Following a feedback session, a re-audit was performed to identify improvements in practice. Results The case mix of both studies was very similar. Revision hip arthroplasty surgery constituted the major subgroup requiring allograft (48%), followed by foot and ankle surgery (16.3%) and revision knee arthroplasty surgery (11.4%) .On the initial audit, 17/45 cases (38%) had either adequate preoperative documentation of the outpatient discussion or an appropriately completed consent form on the planned use of allograft. On the re-audit, 44/78 cases (56%) had adequate pre-operative documentation. There was little correlation between how frequently a surgeon used allograft and the adequacy of consent (Correlation coefficient -0.12). Conclusions Although the risk of disease transmission with allograft may be variable, informed consent for allograft should be a routine part of preoperative discussions in elective orthopaedic surgery. Regular audit and feedback sessions may further improve consent documentation, alongside the targeting of high volume/low compliance surgeons.

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

“…For this reason, they were analysed separately from other specific risks. Media reports have heightened public awareness of the risk of allograft, and other studies have reported poor compliance of documenting consent for its risks 54,55 . The recording of consent for the use of human allograft bone was introduced onto the institutional consent form (Supplementary Information 1) in 2018 after a patient complaint that led to an enquiry by the New Zealand Health and Disability Commissioner 56 .…”

“…Media reports have heightened public awareness of the risk of allograft, and other studies have reported poor compliance of documenting consent for its risks. 54,55 The recording of consent for the use of human allograft bone was introduced onto the institutional consent form (Supplementary Information 1) in 2018 after a patient complaint that led to an enquiry by the New Zealand Health and Disability Commissioner. 56 The case centred on a patient who underwent spinal surgery with allograft and complained that they were not consented preoperatively for the use of allograft.…”

Association between the introduction of a structured form and the quality of diabetes in pregnancy clinic care

“…23 Audit and feedback mechanism, supplemented by several measures including educational activities, appropriate incentives and disincentives, is likely to result in meaningful behavioural change. 24,25 A qualitative audit to ascertain the clinician acceptance and compliance with structured clinical proforma versus freehand case notes is recommended to guide the flexible design of the proforma in future.…”

Effect of Reinforced Audit and Feedback Intervention on Physician Behaviour: A Multifaceted Strategy for Targeting Medical Record Documentation

“…Feedback referred to information about the performance of an individual from an outside source; feedback was conducted in two forms: positive feedback (reinforcing or positive) and negative (constructive or corrective). 13,14 Positive feedback utilised a variety of positive incentives including monetary (pay-forperformance, gift cards, and bonuses) and non-monetary (flexible working hours, vacation days) approaches to reinforce targeted behaviour. 16,17 To amplify the impact of the A&F intervention, an educational guideline assisting residents Implementing the interventions Source of feedback -The head of the surgery department worked as a facilitator and rater for residents' MRD.…”

“…12 Evidence suggests that A&F has a signifi cant impact on changing the behaviour of physicians and is considered to be one of the best approaches to improve professional behaviour and performance in healthcare organisations. 13,14 This study aimed to investigate the effects of multifaceted mechanisms on the improvement of medical records documentation prepared by surgical residents at a tertiary university hospital.…”