Challenging the knowledge base and skillset for providing surgical consent by orthopedic and plastic surgeons in the Netherlands: an identified area of improvement in patient safety

Abstract

BackgroundSuccessfully completing a surgical informed consent process is an important element of the preoperative consult. A previous study of Dutch general surgeons demonstrated that the implementation of SIC did not meet acceptable standards. However, the quality of the SIC process in the orthopedic surgical or plastic surgical arena is unknown.MethodsFollowing ethical approval, an online survey investigating specifics of surgical informed consent was performed among members of the Dutch Scientific Association of Orthopedic Surgeons and the Dutch Society for Plastic Surgery.ResultsA total of 335 responses from a majority of departments of orthopedic (86 %) and plastic surgery (78 %) were eligible for analysis. Scores on knowledge were poor as only 50 % recognized the three basic elements of surgical informed consent (competence, exchange of information and consent). The orthopedic group used more tools in the surgical informed consent process, such as instruction movies and websites or specialized nursing staff, compared to plastic surgery (orthopedic: 31-50 % vs. plastic: 6-30 %, p = 0.05- < 0.001). In contrast, surgical informed consent forms were used more frequently by the plastic surgical group (orthopedic 21 % vs. plastic:42 % p < 0.001). Control of the efficacy of the surgical informed consent process was low, 36 % in both groups. One in every seven orthopedic or plastic surgeons was faced with an official surgical informed consent-related complaint in the previous five years.ConclusionsSimilar to general surgeons, Dutch orthopedic and plastic surgeons demonstrate poor knowledge and skills regarding surgical informed consent. Increased awareness, better training and use of modern tools including standard forms and online software programs will improve the SIC process and will optimize patient care.Electronic supplementary materialThe online version of this article (doi:10.1186/s13037-016-0110-0) contains supplementary material, which is available to authorized users.

Development and validation of a risk stratification model for immediate microvascular breast reconstruction

“…The current focus on quality improvement in surgery recognizes the need for more precise evidence‐based and outcome driven preoperative decision‐making . In this study, we demonstrate that a simple risk score, based on known preoperative variables, can provide accurate risk stratification for patients considering immediate microvascular breast reconstruction.…”

Máximazing the quality of perioperative patient counselling

“…Moreover, it will improve patient satisfaction, safety and prevent high impact malpractice claims. 1,[32][33][34][35] In recent years, preoperative safety programs (SURPASS) have structured and improved patient safety significant, but there was little interest in the aspects of SIC. 33 A standard SIC form was introduced and successfully implemented in daily practice in various countries including Australia and the UK.…”

“…1,[32][33][34][35] In recent years, preoperative safety programs (SURPASS) have structured and improved patient safety significant, but there was little interest in the aspects of SIC. 33 A standard SIC form was introduced and successfully implemented in daily practice in various countries including Australia and the UK. 23 According to the present study, the SIC process in the Netherlands is highly dependent on local and personal circumstances.…”

“…29 Interestingly, they usually do not feel the need for more information and their actual knowledge of the benefits and risks involved remains poor. [31][32][33][34][35] In contrast, when asked what information they would like to have, they indicate that they would like more information than they actually receive. 36 Several misconceptions also exist with respect to voluntariness.…”

“…Substantial weaknesses and omissions of SIC are evident and the current elements of the SIC process are largely neglected in daily practice. 19,20,[27][28][29][30][31][32][33][34][35][37][38][39]41,44,45,47,48 Preconditions are ignored, information is incomplete, and the consent itself is not an accurate reflection of the patient's authorization. SIC apparently is not a popular part of the doctor-patient relationship, and presumably both parties are guilty.…”