Improving consenting practice in trauma and orthopaedics: A single centre original mixed methods study

Informed consent represents a cornerstone of ethical and legal surgical practice across numerous healthcare systems, including that of the United Kingdom. Despite its recognised importance, achieving consistency and comprehensiveness in the consent process remains a persistent challenge, particularly within busy and time-constrained clinical environments. This study critically evaluates existing consenting practices in the Department of Trauma and Orthopaedics at Worcestershire Acute Hospitals. It also presents the department's experience with implementing electronic consent (e-consent) forms as a replacement for traditional handwritten documentation.

A two-phase study was conducted at a single National Health Service (NHS) trust. In the first phase, 102 handwritten surgical consent forms were retrospectively audited against national guidelines to assess compliance in areas such as timing of consent, legibility, provision of information, and documentation of risks and alternatives. The second phase involved a structured survey of clinicians within the orthopaedic department to explore their experiences with the current process and their perceptions of electronic alternatives.

The audit revealed major shortcomings in the handwritten consent process: only 21 % of forms were completed well in advance of surgery, fewer than half provided adequate procedural information, and just 17 % documented all available treatment options. Over 60 % were poorly legible, and most lacked complete documentation of risks and benefits. Survey results indicated widespread clinician dissatisfaction and a strong preference for e-consent systems to improve legibility, clarity, and patient engagement.

The study highlights significant deficiencies in handwritten consent practices and supports adopting standardised e-consent systems to enhance communication, patient comprehension, and medico-legal protection.