726 Consenting for Surgery During the Pandemic: A Closed-Loop Audit on Discussing and Documenting the Risks of Hospital-Acquired COVID-19

Abstract

IntroductionThere is limited data on the nosocomial transmission of COVID-19. The Royal College of Surgeons (RCS) have published guidance on consenting for surgery, which includes discussing the risks of hospital-acquired COVID-19 with patients as part of the consenting process1. We performed a closed-loop audit on our unit’s consenting practice to assess compliance using the RCS guidelines as the audit standard.MethodA retrospective case review, including elective and emergency procedures, were identified from June to November 2020. Consent forms were reviewed for evidence of patient counselling for the risks of hospital-acquired COVID-19 using the RCS guidance for comparison. Positive SARS-CoV-2 RT-PCR swabs and radiological imaging suggestive of COVID-19 within 30-days were also assessed.We undertook the 1st cycle of data collection in September. Following this, we used a local meeting to educate the surgical team. The 2nd cycle (re-audit) was performed in December.ResultsIn cycle 1, from June to August 17/29 (59%) case notes documented the discussion of the COVID-19 risk. None of these patients contracted the virus. In cycle 2, from September to November, compliance improved to 28/33 (80%). One (3%) patient had contracted COVID-19. They had a positive SARS-CoV-2 RT-PCR swab and signs suggestive of COVID-19 on their CT chest.ConclusionsThe re-audit demonstrated an improvement in our consenting practice from 59% to 80%. One patient had hospital-acquired COVID-19 during our period of data collection, which reflects current data that suggests nosocomial COVID-19 is rare2. With new advisory guidelines, it is important to discuss these risks.