Consenting Operative Orthopaedic Trauma Patients: Challenges and Solutions

Guidelines exist to obtain informed consent before any operative procedure. We completed an audit cycle starting with retrospective review of 50 orthopaedic trauma procedures (Phase 1 over three months to determine the quality of consenting documentation). The results were conveyed and adequate training of the staff was arranged according to guidelines from BOA, DoH, and GMC. Compliance in filling consent forms was then prospectively assessed on 50 consecutive trauma surgeries over further three months (Phase 2). Use of abbreviations was significantly reduced ( ) in Phase 2 (none) compared to 10 (20%) in Phase 1 with odds ratio of 0.04. Initially, allocation of patient’s copy was dispensed in three (6% in Phase 1) cases compared to 100% in Phase 2, when appropriate. Senior doctors (registrars or consultant) filled most consent forms. However, 7 (14%) consent forms in Phase 1 and eleven (22%) in Phase 2 were signed by Core Surgical Trainees year 2, which reflects the difference in seniority amongst junior doctors. The requirement for blood transfusion was addressed in 40% of cases where relevant and 100% cases in Phase 2. Consenting patients for trauma surgery improved in Phase 2. Regular audit is essential to maintain expected national standards. 1. Introduction Health professionals have a legal and ethical obligation to obtain valid informed consent before any procedure to be performed. Consent is as fundamental as any other basic principle on which surgical practice relies, and its use in patient care is a clinical skill [1]. Guidelines have been developed by professional bodies highlighting the importance of the principles and the process of seeking consent [2–4]. The importance of establishing informed consent form is to reflect the requirement to ensure that essential and sufficient information has been imparted between patient and health professional (surgeon) [4]. Consent is a two-way process. The health professional should know the patient’s history and problems. The patient must be given time to ask relevant questions. The health professional must check understanding and offer alternative treatments. They must explain relevant risks and benefits. This combination will ensure that the correct procedure is being performed on the correct patient [5]. The requirement for consent has now explicitly been extended to the disposal of human tissue and the management of personal data. Although these extensions are not a central issue for surgeons,they obviously include massive implications during the consent process. Hence, the other members of the