What constitutes a “material risk” when consenting in acute orthopaedic trauma admissions?

Aim: A study to evaluate knowledge among junior doctors as to what constitutes a “material risk” and therefore warrants mention during the consent process for 4 routine trauma operations: dynamic hip screw, hemiarthroplasty, distal radius open reduction internal fixation (ORIF) and ankle ORIF.

Methods: Data were collected through a written survey. Actual consent forms completed on the orthopaedic wards were prospectively reviewed to determine if individuals were consistent in application of knowledge, and to determine if practice varied among the trainee cohort. Responses were compared with British Orthopaedic Association consent guidelines.

Results: This project demonstrated that 13 trainees who enrolled in the study had variable knowledge of the “material risks” of 4 routine trauma operations (67.8% overall compliance per questionnaire). Performance was not linked to seniority of trainee. Trainees were also not consistent in putting theory into practice, with many procedure-specific “material risks” missing on actual consent forms despite documenting the risks in the questionnaire (56.2% overall compliance in practice, P = 0.003).

Conclusions: Actual documentation on consent forms is poor, and trainees usually neglect to document several risks on each form despite knowing they are “material risks”. Use of pre-printed forms where “material risks” are already stated is a possible solution.