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Informed consent for patient transfers to a Veterans Affairs medical center
D F Jablonski1, G M Mosley, J C Byrd
1Division of General Internal Medicine, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin 53295.
Objective:
To evaluate whether informed consent was obtained prior to transfers of patients from a community hospital to a Veterans Affairs medical center.
Design:
Cross-sectional study.
Setting:
A Department of Veterans Affairs medical center.
Participants:
Eighty-six consecutive interhospital-transferred patients. Nearly all were white men, with a median age of 62.5 years. Fifty percent had three or more active medical problems and 17% had been transferred from intensive care units.
Measurements And Main Results:
The authors defined informed consent as a discussion of benefits, risks, and alternatives to transfer. Following transfer, patients and physicians were interviewed using standardized parallel questionnaires. Physician-patient communication regarding the benefits and risks of transfer was infrequent. Informed consent was reported for none of the transfers by patient interview, compared with 11% of the transfers assessed by physician interview. Risks of transfer were discussed infrequently according to both physicians (17%) and patients (13%). Physicians perceived a risk to the patient in 21% of patient transfers, and in 36% of transfers defined by objective criteria as high-risk. Physicians recalled discussing benefits of transfer more frequently than did patients (80% vs. 42%,t test, p less than 0.001). Physicians also recalled discussing alternatives to transfer more frequently than did patients (61% vs. 18%, t test p less than 0.001).
Conclusions:
Verbal informed consent is obtained infrequently prior to interhospital transfer of patients. Risks of transfer are seldom perceived and discussed with patients.