Keywords
Informed Consent
Audit
Electronic Patient Records
How to Cite
Abstract
Background
Advance consent is crucial for patients undergoing Interventional radiology (IR) procedures with potential serious harm. Two previous audits at our hospital revealed issues with obtaining consent before the day of the procedure, leading to the implementation of a consent clinic. Subsequently, a new electronic patient record (EPR) system was introduced. This third audit cycle assessed whether these changes improved the advance consent rates for vascular IR procedures.
Method
We retrospectively reviewed 53 patients who underwent vascular IR procedures in January 2023, noting whether each procedure was inpatient or outpatient, urgent or elective, and the procedure type. These results were compared with previous cycles to evaluate adherence to consent standards.
Results
Among the 53 patients, there was an even split between inpatient and outpatient procedures, as well as between urgent and elective procedures. 27 patients underwent lower limb angiogram/angioplasty, 19 had fistula work, and 7 underwent other procedures. 77% of patients consented in advance or had the consent process initiated beforehand.
Conclusion
An improvement in advance consent rates was noted compared to previous cycles (14% → 63% → 77%) following the implementation of consent clinics and the new EPR system. However, 33% of patients, primarily those undergoing fistula work, still consented on the day of the procedure. This audit highlights the benefit of the new EPR system and the need to continue consent clinics, emphasizing the importance of advance consent, especially for fistula procedures.
References
Decision making and consent - professional standards - GMC [Internet]. [cited 2024 Nov 20]. Available from: https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/decision-making-and-consent
Schenker Y, Fernandez A, Sudore R, Schillinger D. Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: A Systematic Review. Medical Decision Making. 2011;31(1):151-173. doi:10.1177/0272989X10364247
Levett, D.Z.H. and Grimmett, C. (2019), Psychological factors, prehabilitation and surgical outcomes: evidence and future directions. Anaesthesia, 74: 36-42. https://doi.org/10.1111/anae.14507
Hagendijk, M. E., Zipfel, N., Melles, M., van der Wees, P. J., Hulshof, C. T. J., Çölkesen, E. B., … van der Burg-Vermeulen, S. J. (2024). Towards person-centred work-focused healthcare for people with cardiovascular disease: a qualitative exploration of patients’ experiences and needs. Disability and Rehabilitation, 47(1), 194–206. https://doi.org/10.1080/09638288.2024.2344653
Max M. Feinstein, Janet Adegboye, Joshua D. Niforatos, Richard M. Pescatore, Informed consent for invasive procedures in the emergency department, The American Journal of Emergency Medicine, Volume 39, 2021, Pages 114-120, ISSN 0735-6757, https://doi.org/10.1016/j.ajem.2020.01.035.
Elwyn G, Durand M A, Song J, Aarts J, Barr P J, Berger Z et al. A three-talk model for shared decision making: multistage consultation process BMJ 2017; 359 :j4891 doi:10.1136/bmj.j4891
Consent to treatment - NHS [Internet]. [cited 2024 Nov 21]. Available from: https://www.nhs.uk/conditions/consent-to-treatment/
NHS England » Decision making and consent [Internet]. [cited 2024 Nov 21]. Available from: https://www.england.nhs.uk/personalisedcare/shared-decision-making/why-is-shared-decision-making-important/decision-making-and-content/
Sharma P, Arya A, Singh S. Informed consent for orthopaedic surgery: A prospective audit. Clin Gov. 2003;8(3):236–41.
de Guzman GS, Amosco MDL. Patient experience and decisional satisfaction with the informed consent process for elective gynecologic surgeries: A cross-sectional study. Annals of Medicine and Surgery [Internet]. 2022 Sep 1 [cited 2024 Dec 22];81:104551. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9486853/
Failures of informed consent & the impact on women’s health - Patient Safety Learning [Internet]. [cited 2024 Dec 22]. Available from: https://www.patientsafetylearning.org/blog/failures-of-informed-consent-and-the-impact-on-womens-health#_ftn14
First Do No Harm The report of the Independent Medicines and Medical Devices Safety Review. 2020 [cited 2024 Dec 22]; Available from: www.gov.uk/official-documents.
‘Mesh removal surgery is a postcode lottery’ - patients harmed by surgical mesh need accessible, consistent treatment - Women’s health - Patient Safety Learning - the hub [Internet]. [cited 2024 Dec 22]. Available from: https://www.pslhub.org/learn/patient-safety-in-health-and-care/womens-health/%E2%80%98mesh-removal-surgery-is-a-postcode-lottery%E2%80%99-patients-harmed-by-surgical-mesh-need-accessible-consistent-treatment-r5652/
Wu CHK, Luk SMH, Holder RL, Murdoch I. How do paper and electronic records compare for completeness? A three centre study. Eye [Internet]. 2018 Jul 1 [cited 2024 Nov 20];32(7):1232. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6043594/
Reference guide to consent for examination or treatment (second edition) - GOV.UK [Internet]. [cited 2024 Nov 20]. Available from: https://www.gov.uk/government/publications/reference-guide-to-consent-for-examination-or-treatment-second-edition
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2025 Array