Looped quality improvement project of consent forms in patients admitted with hip fracture

Neck of femur (NOF) fractures constitute a significant proportion of the workload of orthopaedic departments, with approximately 65 000 admissions across the UK annually. There are various surgical procedures available to repair NOF fractures and each is associated with numerous intraoperative and perioperative risks. Informed consent is an essential part of the workup when planning to undertake any surgical procedure, whereby the risks and benefits of surgery are discussed with the patient, so they are able to make decisions about their care. It is therefore important that consent forms are sufficiently detailed and accurate to ensure consent is fully informed.

We performed a multi-loop audit of consent forms for patients admitted to the Royal Oldham Hospital (United Kingdom) with NOF fracture. The frequency that different risks were included on consent forms was compared to the British Orthopaedic Association (BOA)-produced standardised list of risks for NOF fracture procedures.

We found that on each consent form an average of only 56.6 % of risks were included before intervention. Some significant risks such as mortality were frequently missed. Following this, we implemented changes to the consent process including the use of stickers to use on consent forms and team education sessions. We subsequently performed a second audit cycle and found that compliance had increased to 87.9 %.

Overall, there was poor documentation of surgical risks on consent forms, however this was improved with basic interventions. A further audit cycle should be recommended to investigate if this improvement is sustained.