A cost–consequence analysis of eLearning videos designed to supplement the consent process in lower limb arthroplasty
J Brock, A Sale, U Jayaraju, A Chandetreya, P Lee
Royal College of Surgeons of England Annals, 19 October 2022
Abstract
Introduction
Since the Montgomery ruling in 2015 surgeons have been tasked with identifying material risk when taking informed consent. Despite this, there has been limited uptake of technological aids to supplement the consent process although such aids are shown to improve patient knowledge and satisfaction. ConsentPLUS is a free-to-access website with bite-sized educational videos designed to clearly explain lower limb arthroplasty procedures to patients and aid their consent.
Methods
We performed a prospective cost–consequence analysis, outlining any costs associated with the intervention and any quantitative or qualitative impacts the intervention may have on patients.
Results
A total of 3,143 consecutive patients were identified who were undergoing total knee or hip replacement in 25 elective NHS orthopaedic units. The total cost of development and projected 10-year running fees for ConsentPLUS total £75,000. Health Foundation support means the service is free-to-access for centres throughout the UK. Mean exposure time per patient was 10min 29s, equivalent to £185,437 of additional contact time according to the National Tariff. Mean clinic time was reduced by 17min owing to the earlier identification of material risk. Patient knowledge on pre- and post-video quizzes increased from 7.01 to 9.08 following eLearning (paired t-test = 0.998). The process had an overall satisfaction rate of 97%.
Conclusion
Educational eLearning videos are an accessible and digestible way to supplement the consent process. This enables earlier identification of material risk in clinics owing to improved patient knowledge, leading to increased patient satisfaction with arthroplasty consenting.

Digitized and structured informed patient consent before contrast-enhanced computed tomography: feasibility and benefits in clinical routine
Original Article
Markus Kopp, Jan Peter Roth, Frederik Geisler, Sascha Daniel, Theresa Ruettinger, Christoph Treutlein, Eva L. Balbach, Rafael Heiss, Matthias Wetzl, Nouhayla El Amrani, Alexander Cavallaro, Michael Uder, Matthias S. May
Insights into Imaging, 11 October 2022; 13(164)
Open Access
Abstract
Background
To evaluate the feasibility and benefits of digitized informed patient consent (D-IPC) for contrast-enhanced CT and compare digitized documentation with paper-based, conventional patient records (C-PR).
Methods
We offered D-IPC to 2016 patients scheduled for a CT. We assessed patient history (e.g., CT examinations, malignant or cardiovascular diseases) and contraindications (red flags) for a CT (e.g., thyroid hyperfunction, allergies) using a tablet device. We evaluated the success rate of D-IPC and compared patient age between the subgroups of patients who were able or unable to complete D-IPC. We analyzed the prevalence of marked questions and red flags (RF). RF were compared with the documentation from C-PR. We estimated greenhouse gas (GHG) emissions for paperless workflow and provide a cost–benefit analysis.
Results
Overall, 84.4% of patients completed D-IPC. They were younger (median 61 years) than unsuccessful patients (65 years; p < 0.001). Patients who marked questions (21.7%) were older than patients without inquiries (median 63.9 vs 59.5 years; p < 0.001). The most prevalent RF was thyroid disease (23.8%). RF were considered critical for contrast-agent injection in 13.7%, requiring personalized preparation. The detection rate for RF documented with D-IPC was higher than for C-PR (n = 385 vs. 43). GHG emissions for tablet production are 80–90 times higher than for paper production. The estimated costs were slightly higher for D-IPC (+ 8.7%).
Conclusion
D-IPC is feasible, but patient age is a relevant factor. Marked questions and RF help personalize IPC. The availability of patient history by D-IPC was superior compared to C-PR.

Informed consent for third molar extraction; a comparison of conventional verbal consent versus video-assisted consent
Ciara Mulvihill
Trinity College Dublin, Dental Science Thesis, 2022
Abstract
Background
The goal of the informed consent process is to provide patients with the necessary educational information, defend their autonomy, and allow active involvement in treatment planning and decision-making. The informed consent process must not only describe the operation in full, but also provide information on the procedure’s rationale, alternative therapies, associated benefits, risks, and complications. However, the process of acquiring informed consent is fraught with issues.
Objective
This research aims to assess if presenting information about third molar extraction via an informative, narrated, animated video changes a patient s perception of the consent process for third molar extraction when compared to conventional verbal/written consent. The outcomes that are evaluated include patient understanding, patient satisfaction and patient anxiety.
Methods
In this post test-only control clinical trial patients scheduled for surgical removal of an impacted mandibular third molar that fulfilled the predetermined criteria were invited to participate in the study. The criterion variable was the presentation of an animated information consent video. Participants were randomly assigned into 2 equal groups receiving either verbal consent or video-assisted consent. After signing the consent form patients then filled out an electronic questionnaire rating their experience of the consent process. At the postoperative review, 7-14 days after the procedure, patients were asked to fill out a questionnaire rating their experience of the consent retrospectively. The outcome variables were patients self-reported level of understanding, patient anxiety measured on the Dental Anxiety Scale and patient satisfaction. The data were analysed with Pearson s chi-squared tests, Fisher s Exact test, and linear regression analysis.
Results
Ninety patients fulfilled the inclusion criteria and were included in the study. The video-assisted group reported higher levels of understanding of the proposed procedure (P<0.001) and the associated risks/complications (P<0.004 ). Patients were more satisfied with information delivered to them via video. 98% of patients in the video consent group felt that the video-assisted consent was beneficial. There was no statistically significant change in the reported level of anxiety when video-assisted consent was used.
Conclusion
The present study suggests that video-assisted consent may improve patients level of understanding of the potential postoperative risks and complications involved in surgical removal of an impacted mandibular third molar. This improved understanding did not increase patients dental anxiety compared with conventional verbal/written consent but improved patients level of satisfaction with the amount of information that they received.