Bundled Consent in US Intensive Care Units

Bundled Consent in US Intensive Care Units
Maria L. Espinosa, Aaron M. Tannenbaum, Megha Kilaru, Jennifer Stevens, Mark Siegler, Michael D. Howell, William F. Parker
American Journal of Critical Care, 1 May 2020; 29(3) e44–e51
Open Access
Abstract
Background
Bundled consent, the practice of obtaining anticipatory consent for a predefined set of intensive care unit procedures, increases the rate of informed consent conversations and incorporation of patients’ wishes into medical decision-making without sacrificing patients’ or surrogates’ understanding. However, the adoption rate for this practice in academic and nonacademic centers in the United States is unknown.
Objective
To determine the national prevalence of use of bundled consent in adult intensive care units and opinions related to bundled consent.
Methods
A random sample of US hospitals with medical/surgical intensive care units was selected from the AHA [American Hospital Association] Guide. One intensive care unit provider (bedside nurse, nurse manager, or physician) from each hospital was asked to self-report use of per-procedure consent versus bundled consent, consent rate for intensive care unit procedures, and opinions about bundled consent.
Results
Of the 238 hospitals contacted, respondents from 100 (42%) completed the survey; 94% of respondents were nurses. The prevalence of bundled consent use was 15% (95% CI, 9%–24%). Respondents using per-procedure consent were more likely than those using bundled consent to self-report performing invasive procedures without consent. Users of bundled consent unanimously recommended the practice, and 49% of respondents using per-procedure consent reported interest in implementing bundled consent.

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