Content, accuracy and completeness of patient consent in a regional vascular surgery unit
1Department of Vascular and Endovascular Surgery, Royal Victoria Hospital, Belfast, Northern Ireland.
Insights
Vascular consent forms in our unit show high compliance with General Medical Council guidelines, nearing 90% completion. However, improving documentation of benefits and reducing abbreviations are key areas for enhancement in patient consent processes.
Area of Science:
- Medical Law and Ethics
- Surgical Patient Care
- Health Information Management
Background:
- The General Medical Council (GMC) provides guidelines for procedural consent in the UK.
- Previous evidence suggests deficiencies in consent form completion, including demographics, procedural risks, and alternative therapies.
- Accurate and complete patient consent is crucial for ethical medical practice and patient safety.
Purpose of the Study:
- To assess the accuracy and completeness of vascular consent forms within a specific clinical unit.
- To identify areas of strength and weakness in the current vascular consent process.
- To ensure adherence to established guidelines for procedural consent.
Main Methods:
- A retrospective review of 323 vascular intervention consent forms from February 2010 to 2011.
- Analysis of consenting doctors' grade, consultant responsibility, procedure details, benefits, complications, and legibility.
- Examination of documentation for alternative therapies and written information provision.
Main Results:
- High compliance (91%) for consent forms completed by specialist registrars or above, with consultant documented in 88.5%.
- 85.4% of patients consented within 48 hours; 94.7% had procedures fully documented, but 51.0% used abbreviations.
- Documentation of benefits was low (31.9%), while complications were noted in 90.7%; written information was provided in only 3 cases.
Conclusions:
- The vascular consent process in the studied unit demonstrates strong adherence to GMC guidance, with nearly 90% compliance in consent-related processes.
- Areas for improvement include enhancing the documentation of intended surgical benefits and providing additional written patient information.
- Reducing the use of abbreviations in consent forms is also recommended for clearer communication.
Objective:
Although the General Medical Council has published guidelines for procedural consent, there is evidence to suggest that deficiencies still occur in completion demographics, documentation of procedural risks and information regarding alternative therapies. We assessed the accuracy and completeness of vascular consent within our unit.
Methods:
A retrospective review of patients undergoing vascular intervention between February 2010 and 2011 was performed. Patient chart examination included the analysis of consenting doctors' grade, responsible vascular consultant, completeness of procedural entry, documentation of correct side, use of abbreviations, discussion of benefits and complications, additional information and overall legibility.
Results:
323 patient consent forms were reviewed (male 203, mean age 68.0 years, elective surgery 241) including 50 AAA repairs, 27 carotid endarterectomies, 88 peripheral arterial reconstructions, 96 amputations and 69 elective varicose vein surgeries. 294 (91%) consent forms were completed by a specialist registrar or above with 286 (88.5%) forms having the responsible consultant documented. 85.4% of patients were consented within 48 h of surgery. 245 (75.9%) consent forms had legible printed names. However, only 75 (23.2%) had a legible signature. 306 (94.7%) consent forms had the procedure documented in full but 165 (51.0%) had used abbreviations. 103 (31.9%) had documentation of the intended benefits of surgery whilst 293 (90.7%) had documentation of potential complications. Three patients had documented evidence of receiving written information and one patient received a copy of the consent form. Of those surveyed, procedural mortality was discussed in 62.5% of open and 47.3% of endovascular AAA repairs. Stroke was documented in 96.3% of consent forms for carotid endarterectomy. Scarring was included most commonly in patients undergoing venous procedures.
Conclusion:
Vascular consent is a complex process involving a number of discussions and meetings with patients. Our unit has demonstrated compliance of nearly 90% for all consent-related processes and remains consistent with current GMC guidance. However, further improvement including the documentation of intended benefits, provision of additional written information whilst reducing the use of abbreviations is desired.
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