Challenging the knowledge base and skillset for providing surgical consent by orthopedic and plastic surgeons in the Netherlands: an identified area of improvement in patient safety.

Leslie Thomas,Marc R. Scheltinga,Johan Legemaate,Wouter K. G. Leclercq,Margot Veerman,Bram J. Keulers,Sarah Sloot,Saskia Houterman

doi:10.1186/s13037-016-0110-0

Abstract

BackgroundSuccessfully completing a surgical informed consent process is an important element of the preoperative consult. A previous study of Dutch general surgeons demonstrated that the implementation of SIC did not meet acceptable standards. However, the quality of the SIC process in the orthopedic surgical or plastic surgical arena is unknown.MethodsFollowing ethical approval, an online survey investigating specifics of surgical informed consent was performed among members of the Dutch Scientific Association of Orthopedic Surgeons and the Dutch Society for Plastic Surgery.ResultsA total of 335 responses from a majority of departments of orthopedic (86 %) and plastic surgery (78 %) were eligible for analysis. Scores on knowledge were poor as only 50 % recognized the three basic elements of surgical informed consent (competence, exchange of information and consent). The orthopedic group used more tools in the surgical informed consent process, such as instruction movies and websites or specialized nursing staff, compared to plastic surgery (orthopedic: 31-50 % vs. plastic: 6-30 %, p = 0.05- < 0.001). In contrast, surgical informed consent forms were used more frequently by the plastic surgical group (orthopedic 21 % vs. plastic:42 % p < 0.001). Control of the efficacy of the surgical informed consent process was low, 36 % in both groups. One in every seven orthopedic or plastic surgeons was faced with an official surgical informed consent-related complaint in the previous five years.ConclusionsSimilar to general surgeons, Dutch orthopedic and plastic surgeons demonstrate poor knowledge and skills regarding surgical informed consent. Increased awareness, better training and use of modern tools including standard forms and online software programs will improve the SIC process and will optimize patient care.Electronic supplementary materialThe online version of this article (doi:10.1186/s13037-016-0110-0) contains supplementary material, which is available to authorized users.

Highlights

Completing a surgical informed consent process is an important element of the preoperative consult
Endorsed and facilitated by both the Scientific Association of Orthopedic Surgeons (NOV) and the Dutch Society for Plastic Surgery (NVPC), an e-mail linked to an online multiple-choice questionnaire was sent in February 2011 and October 2011 to all actively practicing orthopedic surgeons (OS) and plastic surgeons (PS) surgeons and residents in the Netherlands (Table 1)
Knowledge of surgical informed consent (SIC) elements Just over half (OS 51 %, PS 55 %, ns) of the respondents were aware that a competence check of the patient is part of the SIC process (Question 18, Table 3)

Summary

Introduction

Completing a surgical informed consent process is an important element of the preoperative consult. Once properly educated by a surgeon, a shared decision is made whether or not to perform the proposed operation. These basic rights and obligations are incorporated into the surgical informed consent (SIC) process [1,2,3,4]. If the quality of the SIC process is high, patients are better informed and more compliant while results after surgery may be optimized [3, 5, 6]. Patient expectations are more realistic, resulting in more trust in their surgeon and/or surgical procedure and eliciting fewer complaints [3, 5, 6]

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Discussion

Conclusion