Improving the Hip Fracture Surgical Consenting Process: A Single Centre Multi-Cycle Quality Improvement Process

Abstract

Background Hip fractures are a common acute trauma presentation that if requiring surgery, should be performed within 48 hours. Consenting the patient is an important element of the pathway from admission to operating theatre and errors can lead to delayed procedures, medico-legal exposure and may represent a loss of patient autonomy. The aim of this project was to evaluate areas for improvement in our consenting process for patients with capacity and trial new strategies to determine which achieved the greatest improvement. Methods Following a baseline measurement (n=24), deficiencies were noted in three key process measures of clarity of documentation, failure to record procedure-specific risks and not offering a copy of the consent form to the patient. Two quality improvement cycles then followed using targeted teaching for doctors performing the consenting process. Results Cycle 1 (n=26) following targeted teaching demonstrated improved clarity, with a reduction in abbreviations from 38% to 20%, while more than doubling the documentation of discussion of key procedure-specific risks from 31% to 72%. More patients were offered a copy of their consent form, rising from 12% to 48%. Cycle 2 (n=24) saw the introduction of pre-printed “risk of procedure” stickers. Although clarity measures continued to improve, improvements in pre-procedure risk documentation remained broadly static while the number of forms being offered to patients starkly declined to 8%. Conclusions Our project would suggest that while pre-printed stickers can be useful memory aids, specific teaching on consenting produces the greatest benefit. The usage of such tools should therefore be limited, as adjuncts only to detailed training.