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Informed consent for patient transfers to a veterans affairs medical center

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Abstract

Objective:To evaluate whether informed consent was obtained prior to transfers of patients from a community hospital to a Veterans Affairs medical center.

Design:Cross-sectional study.

Setting:A Department of Veterans Affairs medical center.

Participants:Eighty-six consecutive interhospital-transferred patients. Nearly all were white men, with a median age of 62.5 years. Fifty percent had three or more active medical problems and 17% had been transferred from intensive care units.

Measurements and main results:The authors defined informed consent as a discussion of benefits, risks, and alternatives to transfer. Following transfer, patients and physicians were interviewed using standardized parallel questionnaires. Physician-patient communication regarding the benefits and risks of transfer was infrequent. Informed consent was reported for none of the transfers by patient interview, compared with 11% of the transfers assessed by physician interview. Risks of transfer were discussed infrequently according to both physicians (17%) and patients (13%). Physicians perceived a risk to the patient in 21% of patient transfers, and in 36% of transfers defined by objective criteria as high-risk. Physicians recalled discussing benefits of transfer more frequently than did patients (80% vs. 42%, t test, p<0.001). Physicians also recalled discussing alternatives to transfer more frequently than did patients (61% vs. 18%, t test p<0.001).

Conclusions:Verbal informed consent is obtained infrequently prior to interhospital transfer of patients. Risks of transfer are seldom perceived and discussed with patients.

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Authors and Affiliations

  1. Division of General Internal Medicine, Clement J. Zablocki Veterans Affairs Medical Center, 53295, Milwaukee, WI

    Daniel F. Jablonski MD

Authors
  1. Daniel F. Jablonski MD
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  2. G. Michael Mosley MD
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  3. James C. Byrd MD
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  4. Deborah Schwallie RN, MS
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  5. Ann B. Nattinger MD
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Additional information

Received from the Division of General Internal Medicine, Clement J. Zablocki Veterans Affairs Medical Center and the Medical College of Wisconsin, Milwaukee, Wisconsin.

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Jablonski, D.F., Mosley, G.M., Byrd, J.C. et al. Informed consent for patient transfers to a veterans affairs medical center. J Gen Intern Med 6, 229–232 (1991). https://doi.org/10.1007/BF02598965

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