Informed consent for vascular intervention: completing one audit loop

To reaudit documentation of the process of informed consent in patients undergoing vascular surgical and vascular radiological procedures.

A retrospective audit of randomly selected elective vascular radiological and surgical admissions from October 2005-2006 was undertaken to assess the impact of a previous audit on the documentation of the consent process carried out in 2005. Outpatient clinic letters, handwritten entries in the patients' admission notes, and consent forms were scrutinised and data collated on which doctors took consent, when consent was obtained, what details of the consent process were documented, and whether additional information was made available to patients.

99 sets of notes were reviewed (surgical n=50, radiological n=49). For patients undergoing vascular surgery, the consent form was signed by a consultant in 16 (32%) cases compared to 2 (4%) in the previous audit (p=0.013: Chi-squared). Significantly more vascular radiological consent forms were signed by a consultant (43) compared with surgical consent forms (16) (p<0.001; Chi-squared). Documentation that the risks of surgery had been discussed with the patient was present in 31 (62%) surgical notes and in 20 cases such discussions were documented in letters from clinics. For radiological consent documentation, 34 (69.4%) patient notes recorded discussions regarding procedural risk. Twenty-two (44.9%) of the vascular radiological patients had such risks documented in their outpatient notes by a vascular surgeon compared with 1 (2%) (p <0.001; Chi-squared) in the previous audit. Additional written information was given to 7(14%) of the vascular surgical patients which was similar to the previous audit. No additional information was given to patients who underwent vascular radiological procedures.

Significant improvements have been made since the previous audit with more surgical consultants signing the consent forms and increased documentation of the nature of radiological procedures and risks discussed in outpatient clinics. From the current audit, provision of additional written information (patient information sheets) was an area identified for future improvement.