Content, accuracy and completeness of patient consent in a regional vascular surgery unit
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Although the General Medical Council has published guidelines for procedural consent, there is evidence to suggest that deficiencies still occur in completion demographics, documentation of procedural risks and information regarding alternative therapies. We assessed the accuracy and completeness of vascular consent within our unit.
A retrospective review of patients undergoing vascular intervention between February 2010 and 2011 was performed. Patient chart examination included the analysis of consenting doctors’ grade, responsible vascular consultant, completeness of procedural entry, documentation of correct side, use of abbreviations, discussion of benefits and complications, additional information and overall legibility.
323 patient consent forms were reviewed (male 203, mean age 68.0 years, elective surgery 241) including 50 AAA repairs, 27 carotid endarterectomies, 88 peripheral arterial reconstructions, 96 amputations and 69 elective varicose vein surgeries. 294 (91 %) consent forms were completed by a specialist registrar or above with 286 (88.5 %) forms having the responsible consultant documented. 85.4 % of patients were consented within 48 h of surgery. 245 (75.9 %) consent forms had legible printed names. However, only 75 (23.2 %) had a legible signature. 306 (94.7 %) consent forms had the procedure documented in full but 165 (51.0 %) had used abbreviations. 103 (31.9 %) had documentation of the intended benefits of surgery whilst 293 (90.7 %) had documentation of potential complications. Three patients had documented evidence of receiving written information and one patient received a copy of the consent form. Of those surveyed, procedural mortality was discussed in 62.5 % of open and 47.3 % of endovascular AAA repairs. Stroke was documented in 96.3 % of consent forms for carotid endarterectomy. Scarring was included most commonly in patients undergoing venous procedures.
Vascular consent is a complex process involving a number of discussions and meetings with patients. Our unit has demonstrated compliance of nearly 90 % for all consent-related processes and remains consistent with current GMC guidance. However, further improvement including the documentation of intended benefits, provision of additional written information whilst reducing the use of abbreviations is desired.
KeywordsConsent Patient Surgery Vascular
The authors acknowledge Ms. Bonnie Schimek from the Mayo Clinic who provided assistance with all the figures.
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