Current practice of consent for trauma surgery: A time for change?

Abstract

5 Current practice of consent for trauma surgery: A time for change? Steven Churchill*, Cezary Kocialkowski, Ladan Hajipour, Anand Pillai University Hospitals of South Manchester, United Kingdom *Corresponding author. Objectives: The ruling of the Montgomery case this year emphasised the importance of explicit and legally defensible consent in the modern era; the particular nuances relating to informing patients of risks specifically relevant to them. We performed an audit of the current consenting standards in our trauma department to ascertain what can be done to make the consenting process more consistent and justifiable. Methods: We audited 68 consent forms for patients having elective orthopaedic and trauma procedures between February and April 2015. Specifically looking at who consented the patient, the procedure, as well as each risk/complication identified on the form. We also noted any key differences in the way people consented. Results: Consent for 31 trauma procedureswere assessed in the audit: 26 neck of femur (NOF) repairs, three ORIFs and two hip revisions; all of the consent forms were completed by SHO grade doctors. The median day of consent was 1 day pre-procedure. For NOF patients, the proportion consented for specific risks were: pain (53.8%), infection (100%), bleeding (96.2%), leg length discrepancy (11.5%), neurovascular (NV) injury (88.5%), MI (42.3%), DVT/PE (84.6%), fatal PE (3.8%), death (36.4%). Conclusions: Some risks are being well consented consistently such as infection, bleeding and NV injury. However, even though the evidence tells us that the risk of PE following a NOF fracture is around 5% with a 1-year mortality of 20–35%, these are not being consented for universally. This would suggest a more reliable form of consenting maybe appropriate, either through consenting ‘‘stickers’’ or by standardised consent forms. http://dx.doi.org/10.1016/j.injury.2015.12.006