Managing the Flow? A review of the care received by patients who were diagnosed with an aneurysmal subarachnoid haemorrhage…. Colin Shieff, FRCS Trustee Headway UK Consultant Neurosurgeon The National Hospital for Neurology and Neurosurgery

Decision making and consent by the patient Declaration of conflict of interest.. Consultant Neurosurgeon, National Hospital for Neurology and Neurosurgery Trustee, Headway UK

What has happened to me? What can you do about it? What can go wrong? Will I be all right? What do patients and their families ask?...

What do patients complain about?... ‘quality of care’ environment outcome information communication autonomy (lack of) involvement in decision making

Decision making is a shared responsibility… Was conservative management discussed with the patient? yes 53.9% no % insufficient data 13

Who obtains the consent? From? What is discussed? What is (isn’t) recorded? Obtaining consent for intervention

Grade of clinician obtaining consent for Rxn% Consultant Associate specialist/Staff grade2<1 Trainee with CCT72.4 Senior Specialist Trainee Junior Specialist Trainee1<1 Basic Grade1<1 other1<1 subtotal295 n/a14 total309

Deficiencies in consent processn/34 Person from whom consent was obtained6 Lack of discussion with next of kin15 Grade of doctor obtaining consent4 Inadequate description of risk on consent form16 Failure to document risk of death10 Other..7

Source of consentn% Patient Form 4: patient unable to give consent subtotal298 n/k6 n/a5 total309

Source of consent Consent process was adequate DeficienciessubtotalInsufficient data/ no form total patient13124 (15.5%) Form 4526 (10.3%) subtotal n/k40426 n/a11205 total Was the consent process satisfactory?

In summary... there are issues relating to discussion about treatment choice, especially if conservative management has been decided upon.. and in relation to consenting for definitive treatment... ‘who, whom, what is said’...