Bridging gaps in surgical consent: an audit from the SNAPS department

Bridging gaps in surgical consent: an audit from the SNAPS department
Digital Poster
Alizay Rehman, Jennifer Billington, Simon Blackburn
BMJ Paediatrics Open, 17 January 2025
Open Access
Abstract
Introduction
Consent for surgical intervention involves providing patients and their families adequate information and time to make informed decision. An outpatient clinic appointment is crucial for sharing information about surgical diagnosis and necessary interventions. Our objective was to audit the consent process in the Specialist Neonatal and Paediatric Surgery (SNAPS) department at Great Ormond Street Hospital.
Method
The gold standards were consent guidelines by the Royal College of Surgeons, General Medical Council, and National Institute for Health and Care Excellence.1–3 Guidelines recommend taking consent in advance of surgery, such as in clinics, allowing patients ample time to make informed decisions. The consultation should share the following to meet guideline criteria: diagnosis, planned surgery, alternatives, risks, benefits, expected postoperative stay, preoperative instructions, and reading material, all documented in clinic letters. Patients’ notes (clinic letters, consent forms, date of surgery) were retrospectively assessed. During the implementation phase, consensus regarding guidelines was achieved across the surgical team. Smart phrases were created and shared for EPIC clinic letters, meeting guideline criteria, for common SNAPS surgical procedures, followed by a re-audit.
Results
Clinic letters of 70 patients were audited in first cycle. Only 27/70 (38.9%) letters met the criteria. 68/70 (97%) consents were signed on the day of surgery, 2/70 (3%) the day before, with 0/70 in clinic. The average duration between consultation and surgery was 5.39 months. The re-audit analysed 70 letters and demonstrated improvement of 11.1% with 35/70 (50%) letters meeting the criteria as per guidelines.
Conclusion
We demonstrated moderate improvement in surgical consultations by ensuring patients receive adequate information, in accordance with gold standards, with documented evidence in clinic letters. Further progress requires enhancing consent processes in clinics allowing sufficient time for patients to make decision, including consent guidelines in doctor inductions, access to smart phrases and re-auditing after some months.