Deficiencies of Informed Consent Among Anesthesia Providers: An Integrative Review

The purpose of this review was to identify omissions during the informed consent process by certified registered nurse anesthetists (CRNAs) and physician anesthesiologists that were identified in malpractice claims between 1990-2022. Secondary aims included identification of injury, court ruling, and violations of patient rights and ethical principles. Abstracts of cases identified through systematic search on the Casetext database were screened for inclusion by the team's legal expert. Inclusion criteria were claims concluding between 1990-2022, failure to obtain informed consent as a primary or secondary claim, and an anesthesia provider as a defendant. Data from the included cases were extracted into a data matrix and presented in data tables to identify themes. Eighty-five cases were found on initial search, and 24 legal cases were included in the review. Defendants included CRNAs, anesthesiologists, employers of anesthesia providers, and anesthesia trainees. Risks associated with the delivery of anesthesia and failure to obtain informed consent before the delivery of anesthesia were the most frequent omissions by anesthesia providers. Patients' right to informed consent was violated in all cases, while the ethical principle of autonomy was violated in 17 cases. Anesthesia providers should consider reevaluating their communication process for informed consent because recent review of claims reveals adequate informed consent is frequently deficient.