Quality of consent form completion in orthopaedics: are we just going through the motions?

Abstract

Consent plays a vital role in every aspect of medicine and surgery, facilitating the patient in making informed decisions about their treatment. The recently published Reference Guide to Consent, by the Department of Health (DH), notes that, although not a legal requirement, the completion of consent forms is good practice, particularly in interventions such as surgery. In addition, the Parliamentary and Health Service Ombudsman noted that a significant number of complaints about consent involved the complainant feeling that they did not fully understand what was going to happen. It was often found that there was no documentation to clarify what the patient was told, when and by whom. We have performed an audit of 71 randomly selected consent forms, elective and trauma cases within our district general hospital orthopaedics department. Our data demonstrate that a significant number of consent forms were incorrectly or insufficiently completed. This could not only leave the patient confused about their procedure but also leaves the doctor open to litigation, with little in the way of documentation support. Minor changes in consenting methods and more precise documentation could significantly improve patient experience and satisfaction.

The Quality of Consent - What is the Evidence?

“…examined the adequacy of 1280 consent forms and reported that less than one in five were filled out in plain English and that the relevant risks were provided in only one in 25. Two studies from the UK found that the documentation of consent was consistently lacking in nearly all areas set out in the guidelines published by the Department of Health in the UK . These studies suggest the need for the review of practice concerning the consent process.…”

Variability in the Perception of Informed Consent for IV-tPA during Telestroke Consultation

“…Studies of the adequacy of the consent process have largely focused on the extent of the risk explanation by retrospective review of written documentation (Jeyaseelan et al, 2010; Patel et al, 2010; Siddins et al, 2009; Ahmad et al, 2009) and exist mostly in the surgical field. Other studies have used interviews or written questionnaires to focus on the patient’s perceptions of consent, most of which reveal that patients perceive the consent process to be inadequate and often sign consent forms without reading them (Lavelle-Jones et al, 1993; Kay and Siriwardena, 2001).…”

“…Retrospective approaches to studying consent adequacy, most commonly by review of documented risks on the consent form (Ahmad et al, 2009; Siddins et al, 2009; Jeyaseelan et al, 2010; Patel et al, 2010) or by immediate or delayed patient interview or questionnaires (Lavelle-Jones et al, 1993; Kay and Siriwardena, 2001) are limited in gaging the true nature of the consent encounter. Written documentation may not reflect the entire verbal exchange or interaction.…”

An audit of consenting practices in a district general hospital. Can we improve?

“…Jeyaseelan L. et al (8), have reported use of abbreviations in 42.3% of consent forms with incomplete details and only 35.2% of patients were given a copy, they concluded that minor changes in consenting methods and more precise documentation could significantly improve patient experience and satisfaction. Use of abbreviations in consent forms were also reported by Sinha S. et al and Kheiran A. et al (7,9).…”