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A Procedure-Specific Consent Sticker as an Educational Tool to Improve Informed Consent Documentation by Junior
Kapil Agrawal1, Jaspreet Singh Kaur1, Merene Varghese1
1Department of General Surgery, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, United Kingdom.
Objective:
To assess baseline consent documentation for laparoscopic appendicectomy against national standards and evaluate the educational impact of a procedure-specific consent sticker and targeted training programme on documentation completeness among junior surgical clinicians.
Design:
Before-and-after interventional educational study with two sequential study periods separated by a three-month multicomponent intervention phase comprising a procedure-specific consent sticker, targeted education sessions, and a ward reminder poster.
Setting:
A single NHS general surgical unit at a large UK district general teaching hospital (The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom), with consent obtained by foundation year doctors and core surgical trainees.
Participants:
Consecutive adult patients (aged ≥18 years) undergoing emergency laparoscopic appendicectomy: baseline period (n = 68) and post-intervention period (n = 55). All consent was obtained by junior surgical trainees.
Results:
Common risks were well-documented at baseline (bleeding 98.5%, infection 95.6%). Critical deficiencies were identified for death (13.2%), adhesions (23.5%), reintervention (23.5%), and Meckel's diverticulectomy (1.5%). Following the educational intervention, adopted in 54.5% of cases via sticker use, documentation improved substantially: Meckel's 1.5%-90.9% (+89.4 percentage points), death 13.2%-58.2% (+45.0 pp), adhesions 23.5%-60.0% (+36.5 pp), and anaesthetic risk 42.6%-78.2% (+35.6 pp). Subgroup analysis showed complete documentation across all assessed domains when the sticker was used. In non-sticker cases, documentation remained high for some common risks, but important gaps persisted, including absent gynaecological risk documentation in female patients.
Conclusions:
A procedure-specific consent sticker combined with targeted education substantially improved consent documentation completeness among junior surgical trainees, with the greatest gains in previously deficient medico-legally critical domains. This structured educational tool addresses a recognised training gap and offers a scalable, low-cost model for improving consent competency in surgical training programmes.
