By Tricia Dixon-Thomas, MSN, RN
Tricia Dixon-Thomas, MSN, RN
Providers of surgical services need to do better when it comes to informed consent. We need to act on an understanding that informed consent originates from the patient’s right to direct what happens to their body. As such, it is a legal and ethical obligation prior to the initiation of any surgical procedure.
The intent of obtaining informed consent in an ambulatory surgery center (ASC) is to ensure that the patient, or the patient’s representative, is provided with information sufficient to enable them to evaluate a proposed procedure before agreeing to the surgery. Informed consent is a process, not merely a signature on a piece of paper. Treating the process as another item to tick on the pre-surgery checklist can lead to mistakes as well as patient and physician dissatisfaction.
An educational process
The individual steps in obtaining consent can be straightforward, but their importance should not be underestimated. Lack of informed consent remains the most common secondary claim in physician medical malpractice actions, so improving how the request for consent is delivered and understood is essential for everyone involved in the patient’s care.
Patients must be provided with information about the goals of the surgery and their options within any recommended course of treatment. It must be presented in a way they can understand and retain and include an opportunity to express their opinions and ask questions. From this perspective, ask yourself: Are your patients undergoing procedures without exercising true informed consent?
Research has shown poor patient comprehension of key elements of informed consent. This creates risk for patients, clinicians, and organizations, as evidenced by informed consent–related patient safety events such as wrong-site surgery and other complications. Misunderstandings during the consent process can be costly, leading to the delay or cancellation of scheduled surgeries.
Strategies for improved communication
Enhance your process and eliminate miscommunication. The interventions below can be implemented as individual improvements or in combination to build an informed consent process that is more authentic and effective.
- Educate providers.
Physicians can benefit from training on provider-patient communication and shared decision-making. Articulate the impact of informed consent on patient safety. The most effective approach to informed consent begins in the physician’s office when the earliest conversations about a patient’s condition and treatment options are undertaken. Early discussion between provider and patient elevates the level of understanding and serves as a trustworthy foundation for the consent for treatment.
- Educate patients.
- Identify interactive media, graphics and other aids to enhance shared decision making. Many web-based resources feature extensive libraries of standardized, procedure-specific informed consent documents. These have been developed and vetted by physicians from a broad spectrum of medical specialties, and the content of these resources covers risks, benefits and alternatives.
- Provide information to take away following the pre-op appointment. This information can be reviewed together with family members and questions can be written down to review with the surgeon/care team prior to signing the consent.
- Simplify the content, length and language of patient education materials and informed consent documents.
- Ensure materials are respectful of patients’ cultural and language preferences. The use of trained medical interpreters (not family members) to provide full and accurate information is critical.
- Evaluate understanding.
- Engage discussion. Use open-ended questions to encourage active participation by the patient in their own care and to elicit a better assessment of their comprehension.
- Try teach-back methods to confirm that the patient understands the risks, benefits and alternatives to treatment. Teach-back can bring focus to what the patient has understood and where knowledge gaps remain.
Realized benefits
Effective communication helps alleviate patient concerns, improve patient outcomes and promote patient satisfaction. Creating and supporting a culture of open communication, clear expectations and shared decision-making fosters deep respect for patients, builds trust from patients and helps minimize the risk of legal conflict.
Please note: Requirements for informed consent are often determined at the state level. When implementing a new process in your ASC, please check your state requirements to ensure compliance.
– Tricia Dixon-Thomas, MSN, RN, is a clinical review specialist for the ASC and OBS Accreditation Programs at Accreditation Commission for Healthcare (ACHC) with more than 20 years of experience in ASCs.
