Reducing the number of invalid surgical consents in the day surgery unit

Abstract

AimTo reduce the number of invalid surgical consents in the Singapore National Eye Centre Day Surgery Unit over a period of 6 months.MethodologyA multidisciplinary team involving doctors, nurses, day surgery unit, operating theatre, listing and clinical audit staff looked into the listing process and the root causes of the high number of invalid consents. A Pareto chart detailing the top causes of invalid consents was drawn, and with a prioritisation matrix, feasible yet effective changes were identified and effected. Plan-Do-Study-Act (PDSA) cycles included moving consent checks upstream, getting invalid consents amended on the same day, sending emails to raise awareness on invalid consents and posters in clinics to emphasise the correct way to fill up consent forms.ResultThere has been a progressive downtrend in the monthly mean percentage of invalid consents since the introduction of PDSA cycles. There was a significant reduction in the mean rate of rejected consents from the preintervention phase of 15.2% to the postintervention phase of 11.3%, shown with a Z score of 6.56 (P<0.05). Sustainability was also demonstrated with multiple consecutive points below the median of 14.5% on the postimplementation phase of the run chart, with estimated time-efficiency savings of USD$19 738.50 annually.ConclusionErrors in the workplace can be reduced with a concerted effort from multiple stakeholders. It is important to have a thorough look at processes with concerned parties, so that different perspectives and skill sets can be harnessed to determine and implement feasible and effective interventions.

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

“…Commonly for acute trauma admissions, this consenting process is performed by the clerking doctor to prepare the patient for an imminent operation. However often the clerking doctor may not be the surgeon performing the procedure and can be a relatively junior grade who is working under significant time or work pressure (4). These pressures have been noted to result in poor documentation and missed elements of admission notes (5) which can render important documentation such as consent forms substandard or even invalid (4).…”

Improving the surgical consenting process for patients with acute hip fractures: a pilot quality improvement project

“…However often the clerking doctor may not be the surgeon performing the procedure and can be a junior grade physician who is working under signi cant time or work pressure (4). These pressures have been noted to result in poor documentation and missed elements of admission notes (5) which can render important documentation such as consent forms substandard or even invalid (4).…”

“…Previous reviews of litigation relating to informed consent in the United States found errors in recording the risks of a procedure accounted for up to 70% of complaints alone (16). Furthermore, if consent documentation is of poor enough quality to be rendered entirely invalid, this can delay the operative pathway, potentially resulting in cancellation of procedures (4). In a time-critical situation such as hip fractures, these unnecessary delays can therefore signi cantly negatively impact patient care and outcomes.…”

Improving the surgical consenting process for patients with acute hip fractures: a pilot quality improvement project

“…Commonly for acute trauma admissions, this consenting process is performed by the clerking doctor to prepare the patient for an imminent operation. However often the clerking doctor may not be the surgeon performing the procedure and can be a junior grade physician who is working under significant time or work pressure [4]. These pressures have been noted to result in poor documentation and missed elements of admission notes [5] which can render important documentation such as consent forms substandard or even invalid [4].…”

“…Previous reviews of litigation relating to informed consent in the United States found errors in recording the risks of a procedure accounted for up to 70% of complaints alone [16]. Furthermore, if consent documentation is of poor enough quality to be rendered entirely invalid, this can delay the operative pathway, potentially resulting in cancellation of procedures [4]. In a time-critical situation such as hip fractures, these unnecessary delays can therefore significantly negatively impact patient care and outcomes.…”