Part 6 of Access’s Improving the Economy of Surgical Services series
In the previous installment of this series, The Legal Risks of Paper Informed Consents – Surgeons and Hospitals in the Firing Line, we explored how a paper-centric Informed Consent workflow can put surgeons and the hospitals where they practice at legal risk. Now it’s time to turn our attention back to the most important person in the Informed Consent process: the patient.
We cannot overlook or underestimate the negative emotional and physical impact on an already stressed patient when their completed surgical Informed Consent goes missing.
Let’s return to the example from our most recent post, in which you’re a patient with an injured shoulder and I’m your surgeon. After reviewing the results of your MRI, I find there is a significant tear in your rotator cuff and based upon the available options, we both agree that surgical intervention is the best path forward. I explain the potential positive and negative outcomes related to the surgery. I outline what you can expect immediately after surgery along with the recovery process.
I present you with an Informed Consent form that should mirror the verbal explanation of the procedure I’ve just given you. After reading through it, you sign and date the document and I do the same, signaling that you’ve understood the procedure and its risks and that we’ve entered into a mutual agreement to proceed with the surgery.
Fast forward to the day of the procedure.
You get checked in and all seems to be going smoothly. You go through registration; you step through all the “pre-surgery” preparations until at last you find yourself in a hospital gown, on the gurney, trying to manage your growing anxiousness. The clock rolls onto 8:00 a.m., the time of your surgery.
8:05 – No one is talking to you.
8:15 – Still no one has checked in with you.
8:18 – A guy you don’t recognize walks into the room wearing scrubs. He tells you his name is Dr. Jones, and he’s a resident physician.
Next he explains that somehow your Informed Consent—the one you signed weeks earlier with your trusted surgeon—is missing. He needs you to re-consent, which means going through all those procedure details again.
With your state of anxiety now in overdrive, Dr. Jones does his best to describe the rotator cuff procedure in quick detail, but you’re in no state to absorb the information. Wait, did he just say the procedure was going to be on your left shoulder? You correct him indicating it’s your right shoulder. He checks the chart more closely and acknowledges you’re correct then asks for a signature of consent.
Any patient in this situation would feel a host of emotions—confused, angry, scared—and who could blame them? After all, if the hospital can’t even get their paperwork straight, what are they going to do with a scalpel?
The industry numbers don’t lie
This situation is all too real for thousands of patients who have to re-consent due to missing Informed Consents. A JAMA study titled “Missing Consent Forms in the Preoperative Area” found that 66 percent of patients feel uncomfortable when a resident obtains their Informed Consent—and just 47% of residents feel confident in the situation.
An Arthritis Care & Research article by MR Johnson et al. titled “Patient Understanding and Satisfaction in Informed Consent for Total Knee Arthroplasty: A Randomized Study” found that in normal circumstances, only 33 percent of patients could recall the details of their Informed Consent a week after they’d signed it. So in an emotionally distressed state, their absorption of the information is probably even lower. This alone could give a patient grounds to file a lawsuit in which they claim that, while they did consent to surgery, they were not properly informed about it.
Prevent informed consent failures with eForms
Fortunately, all this uncertainty and stress is avoidable. By replacing hard copies of Informed Consents with electronic forms, the entire patient experience becomes easier and more intuitive.
Electronic Informed Consents allow you to pre-populate patient and procedural information on the form, saving tremendous time for surgeons and patients alike. Because electronic Informed Consents are tablet-integrated, providers and patients review procedural information and risks using an iPad. It’s quick and straightforward. Patient’s electronically sign right on the tablet, which includes a time and date stamp. And perhaps, most importantly, the electronic Informed Consent would never get lost in the paper shuffle!
Once the surgeon also electronically signs the consent, it’s automatically attached to the correct patient chart via seamless integration with your EMR system. This means when the OR team performs their document review the morning of surgery, the Informed Consent is right there where it should be. The surgical team has the informed consent they need and the patient moves through their surgery day without any unnecessary hassles.
It’s important to note: A better patient experience isn’t just a noble thing to aim for, improved satisfaction leads to higher HCAHPS scores—and those directly tie to your hospital’s reimbursement. A streamlined surgery experience, happier patients, increased revenue— that’s what I’d call a win-win-win situation.
Koller, Sarah et al., “Efficacy of a Comprehensive Educational Program to Improve Surgical Residents’ Comfort Obtaining Informed Consent,” Journal of the American College of Surgeons, Volume 221, Issue 4, S51.
Garonzik-Wang, Jacqueline M., Gabriel Brat, Jose H. Salazar, Andrew Dhanasopon, Anthony Lin, Adesola Akinkuotu, Andres O’Daly, et al. 2013. “Missing Consent Forms in the Preoperative Area: A Single-Center Assessment of the Scope of the Problem and Its Downstream Effects.” JAMA Surgery 148 (9): 886–89.