Informed Written Consent for Orthopaedic Trauma in the Emergency Setting at a Tertiary Referral Centre: A Closed-Loop Audit

Abstract

Introduction The purpose of this investigation was to perform an audit of the standards of consent forms in which patients sign prior to operative intervention for orthopaedic trauma in an emergency setting in our institution, with comparison to the ‘Orthopaedic Surgical Consent’ standards, as set by the American Association of Orthopaedic Surgeons (AAOS) . If required, the investigator aimed to close the loop in this audit by educating orthopaedic surgeons on the necessary standards of obtaining written consent for orthopaedic trauma. Methods Following being granted approval by our institutional audit committee, a pre-intervention cycle was performed to assess the quality of consent obtained in written format using electronic patient records in consecutive patients over a four-week period. Following the analysis of this data, an education session was provided for all orthopaedic doctors responsible for obtaining informed written consent from patients who are planned to undergo operative management of a soft tissue or bony injury by the trauma and orthopaedic service in the emergency setting. Thereafter, a post-intervention cycle was performed with subsequent descriptive analysis using the GraphPad software. Results In the pre-intervention audit cycle, all included (n = 107) consent forms (100%) correctly included the patient’s name, date of birth (DOB) and institutional board number (BN). However, only 79 consent forms (74.5%) were completed without using abbreviations or acronyms of any kind, whilst 81 consent forms (76.4%) were completed without correctly stating the side or site of the planned intervention. In the post-intervention cycle, all included (n = 40) consent forms (100%) correctly included the patient’s name, DOB and institutional BN. Additionally, a total of 37 consent forms (92.5%) were correctly completed without using abbreviations or acronyms of any kind (74.5% versus 92.5%, p = 0.02). Furthermore, a total of 39 consent forms (97.5%) were completed correctly stating the side or site of the planned intervention (76.4% versus 97.5%, p = 0.0015). Conclusion This closed-loop audit found that the quality of informed consent obtained by orthopaedic surgeons in the emergency setting might potentially be significantly improved with at least one virtual education session. Such simple education sessions may potentially improve the documentation of the planned potential operative intervention by orthopaedic surgeons for cases of orthopaedic trauma to ensure patient safety is optimised. As the turnover of non-consultant hospital doctors is high in university teaching hospitals, regular education sessions on such topics may introduce a cultural shift in maintaining high standards when marking and consenting patients in the emergency setting.

Informed Written Consent for Emergency and Elective General Surgery at a Model 4 Hospital: A Closed-Loop Audit

“…Although guidelines emphasize the importance of clear, concise, and non-abbreviated consent forms, standardization remains a challenge [ 15 , 16 ]. Standardized forms have been shown to be easier to read and understand.…”

“…Currently, in Ireland, there is a high turnover in university teaching hospitals with NCHD staff rotating through different hospitals annually. This makes it difficult to establish a formal culture of consenting but also highlights the urgent need for standardized consenting as a method to resolve this issue [ 16 ]. At the moment, no standardized consent forms for elective and emergency general surgical procedures exist within the Republic.…”

“…It is proven by this study that education plays an important role in the consent process. Online and traditional teaching sessions have shown great promise in improving patient recall of consent and consent procedures [ 16 ]. However, data specific to general surgeons obtaining written informed consent are lacking.…”

Improving Acute Orthopaedic Admission Note Documentation Standards at a Tertiary Centre Through Proforma Introduction: A Quality Improvement Initiative

“…Regarding potential limitations, as is a feature of all such studies, bias may have been introduced through the retrospective nature of the study. As part of the intervention, an education session accompanied the proforma introduction, which may have contributed partly to the significant improvement seen, as seen in other audit studies [ 24 ]. Nonetheless, we feel that these findings are of benefit to the broader orthopaedic community, providing encouragement and a roadmap for the introduction of admission proforma for acute orthopaedic trauma admission in other units which will only be of benefit to patient care.…”

Parental Educational Intervention to Facilitate Informed Consent for Pediatric Procedural Sedation in the Emergency Department: A Parallel-Group Randomized Controlled Trial

“…Furthermore, the importance of adequate education and training for healthcare providers to deliver structured and comprehensive patient information should not be underestimated [ 65 , 66 ]. No specific training for obtaining consent was provided for our healthcare providers, and the consent process for each individual physician might be different.…”