Regional Audit: Valid and Informed Consent for Lower Limb Arthroplasty in Orthopaedic Surgery: Are We Doing Enough?

Regional Audit: Valid and Informed Consent for Lower Limb Arthroplasty in Orthopaedic Surgery: Are We Doing Enough?
Z Sohail, R Mills, O Adebayo, G Mamarelis, F Acquaah, S Subhash, I Liew
British Journal of Surgery, 19 August 2022; 109(Supplement 6)
Abstract
Aim
To investigate regionally the validity of the patient consent process for lower limb arthroplasty, compared to set data standards, with a view to investigating whether the consent process could be improved, and if so, how?
Method
Regional data from 8 hospital trusts (50 data sets collected from each hospital) across England was collected retrospectively from May 1st, 2021, (25 THR, 25 TKR), collated and collectively analysed against agreed, pre-determined set criterion. Data standards included ascertaining whether alternatives to surgery were offered and exploring the likely benefits and risks. Capacity to consent for procedure-specific surgery was measured as patients’ ability to understand, weigh up, retain, and communicate their decisions regarding surgery. Hospitals regional data was collectively analysed.
Results
Capacity was only successfully fulfilled and documented regionally in 11.6% of hip and 13.9% of knee replacement surgeries, despite Consent Form 1 having been filled out in 94.8% and 88.5% of cases respectively, which were procedure specific in only 74.0% and 72.1% of cases.
Conclusions
Significant improvement can clearly be made to an area of already such high clinical negligence claims. We propose a novel solution involving the digitalisation of the consent process, including multimedia surgical videos to better inform patients and reliably assist in establishing the validity of a patient’s consent. The implications of this are limited not only to Orthopaedic surgery but could have far-reaching consequences across all surgical (and indeed medical) specialties, where obtaining valid and informed consent for procedures remains integral to quality patient care.

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