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Documenting informed consent in elective hip replacement surgery: a simple change in practice
Jennifer Isherwood1, Benjamin Dean, Hemant Pandit
1Department of Surgery, Nuffield Orthopaedic Centre, Oxford, UK. jisherwood@doctors.org.uk
Insights
Introducing procedure-specific complication stickers significantly improved informed consent documentation for hip replacement patients. This simple measure enhanced patient care and satisfaction by ensuring better communication of risks and complications.
Area of Science:
- Medical Documentation
- Patient Safety
- Surgical Consent
Background:
- Informed consent is crucial in healthcare, yet documentation of risks and complications can be inadequate.
- Failures in documenting informed consent may lead to patient dissatisfaction and litigation.
- An initial audit in 2009 highlighted deficiencies in documenting risks for primary hip replacement surgery.
Purpose of the Study:
- To evaluate the effectiveness of introducing procedure-specific complication stickers in improving informed consent documentation.
- To determine if this intervention led to significant improvements in documenting potential risks and complications for hip replacement patients.
- To assess the impact of a simple, low-cost intervention on the quality of informed consent processes.
Main Methods:
- A re-audit was conducted on 100 consecutive patients undergoing primary total hip replacement.
- Standardized data collection sheets were used to assess consent forms.
- The re-audit compared documentation practices before and after the introduction of procedure-specific complication stickers.
Main Results:
- The use of procedure-specific complication stickers increased significantly, with 86% of forms utilizing them.
- Statistically significant improvements were observed in the documentation of numerous complications, including fracture, neurovascular damage, and implant failure (P<0.0001).
- Improvements were noted across a wide range of potential adverse outcomes, from medical complications to long-term issues like pain and stiffness.
Conclusions:
- The implementation of procedure-specific complication stickers is a cost-effective and simple method to enhance informed consent documentation.
- This intervention demonstrably improved the thoroughness of risk communication for hip replacement surgery.
- Embracing such simple measures is vital for advancing patient-focused care and satisfaction within healthcare systems like the NHS.
Abstract:
Adequate documentation of informed consent is an important aspect of many doctors' work and failings in this area may result in patient dissatisfaction or litigation. In 2009 the documentation of risks and complications on the consent forms of patients undergoing primary hip replacement was audited at a specialist centre. Following this audit procedure-specific complication stickers were introduced in an attempt to improve the documentation of the consent process. This article discusses the results of a re-audit and aims to determine if this change in practice had resulted in any significant improvement in documentation. The consent forms of 100 consecutive patients undergoing primary total hip replacement were re-audited using a standardized data collection sheet in order to close the audit loop. The re-audit found that 86 consent forms used the procedure-specific complication sticker to list the potential complications associated with a total hip replacement. Statistically significant improvements in the documentation of fracture, neurovascular damage, leg length discrepancy, failure, premature loosening, death, medical complications, ongoing pain, stiffness, wound healing problems and other were all seen in the 2012 re-audit in comparison to the 2009 audit (P<0.0001). The cheap and simple introduction of procedure-specific complication stickers in order to help surgeons document the process of informed consent has resulted in significant improvements in practice. In the context of patient-focused care and satisfaction in the NHS, it is vital that simple measures such as the introduction of procedure-specific complication stickers are embraced.
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