Consenting for acute orthopaedic trauma admissions; Assessing current practice

Aim: The Supreme Court Judgement of Montgomery vs. Lanarkshire (2015) has prompted a shift in approach to gaining informed consent. This closed loop audit identifies current consenting practice for 4 common trauma operations and aims to improve practice using procedure-specific consent forms.

Methods: A prospective audit of consent forms for hip hemiarthroplasty, surgical fixation of hip fracture, ankle fracture and distal radius fracture was performed. Printed forms, with procedure-specific risks documented (as per BOA guidelines – www.orthoconsent.com) for each of the 4 procedures, were then made available. The second cycle then audited practice following introduction of these procedure-specific forms.

Results: 83% of consent forms were completed by trainees of grades ST1-3. In the first audit cycle (n=72), overall adherence to BOA guidelines was 57.7% - this improved in the second cycle (n=72) to 77.7% (p<0.001), despite 56.9% usage of procedure-specific forms.

Conclusion: Completion of common trauma consent forms is poor. Improvement was seen through use of electronically generated forms. Trauma consenting is often done out-of-hours by junior grades who may find the use of a procedure-specific form a useful aide-memoir.