Documentation of Consent in Appendicectomy: A Closed Loop Quality Improvement Project

Documentation of Consent in Appendicectomy: A Closed Loop Quality Improvement Project
Ismay Fabre, Kellie Bateman, Anil Ghosh
British Journal of Surgery, 17 January 2025
Abstract
Aim
The aim of this quality improvement project was to enhance documentation of informed consent for patients undergoing diagnostic laparoscopy and/or appendicectomy, ensuring compliance with legal standards and the Montgomery ruling.
Methods
Retrospective data were collected in an initial audit followed by two Plan-Do-Study-Act (PDSA) cycles from handwritten consent forms of adult patients listed for emergency diagnostic laparoscopy and/or appendicectomy. Data included: grade of consenting clinician, pre-operative imaging, and documentation of recognised risks, for example, conversion to open and drain insertion. Interventions implemented between cycles included providing EIDO leaflets on the surgical unit and teaching consent practices during induction.
Results
Data from 54 patients were analysed (Initial=18, Cycle1=15, Cycle2=21). Consent was performed by SHO’s in 38%-47%. Significant improvements were observed in documenting risks such as blood transfusion (0% to 71.4%), drain insertion (16.7% to 85.7%) and adhesions (38.9% to 76.2%). Documentation of risks such as damage to structures, bleeding and infection remained above 90% throughout. EIDO leaflet use increased from 11.1% to 80.0% within the first cycle but decreased (66.7%) in the second. Overall documentation of COVID risk decreased from 66.7% to 28.6%.
Conclusion
The initial cycle revealed poor documentation of risks, correlating with lack of informed consent. Subsequent PDSA cycles demonstrated significant improvement, particularly in recording recognised risks such as blood transfusion, drain insertion and adhesions. These improvements align with the Montgomery ruling, which requires detailed disclosure of risks to patients. Continued focus and further implementation of information leaflets/ digital resources is required to ensure consistent practice.