Are patients giving consent for their anaesthetic?

Background 1 DoH, Good practice in consent implementation guide: consent to examination or treatment Open letter from the RCoA, Consent for care or treatment given by an anaesthetist AAGBI, Consent for Anaesthesia Revised Edition BLT, Patient Information Leads Reference Guide

Background 2 Study: 111pts Questionnaire prior to pre-op visit Information received & patient satisfaction Anaesthesia:64% spoke to “nobody” beforehand 62% received no information 59% would have liked more Nurses (40%) most frequent providers Williams OA, Patient knowledge of operative care. Journal of the RSM (6):

Aims 1.Determine if pts spoke to “someone” about their anaesthetic before the day of their operation & who. 2.Determine if pts were given a patient information leaflet (PIL) before the day of their operation. 3.Determine if pts were offered an outpatient appointment (OPA) with an anaesthetist before the day of their operation. 4.To determine if pts wanted more information & by what means.

Method 1 1.Included all pts attending Barts Day Surgery Unit for 11 weekdays. 2.All pts were give a questionnaire when they reported to reception. 3.Asked to complete the questionnaire of their own accord while waiting for their pre-operative visit from their anaesthetist. 4.Asked to “post” all completed & uncompleted questionnaires into a red box. 5.The Day Surgery used register was used to confirm the number of pts included in the study.

Questionnaire 1 1.Date of operation & gender 2.Can you communicate easily in English? Y/N 3.If no, what is your preferred language? 4.Have you received an anaesthetic before? Y/N 5.Has someone spoken to you about your anaesthetic before today? Y/N 6.If yes, who? (Nurse, GP, Anaesthetist, Surgeon, Other)

Questionnaire 2 7.Have you received a PIL about your anaesthetic before today? Y/N 8.Were you offered an OPA with an anaesthetist before today? Y/N 9.Would you have liked more information about your anaesthetic before today? Y/N 10.If you answered yes, which would you prefer? (PIL, Web page address, OPA with an Anaesthetist)

Results pts: OMFS (7)Urology (9) Gynaecology (10)Plastics (7) Gen. Surgery (9)Vasc. Surgery (8) CR Surgery (10)Orthopaedics (22) Pain (25)STOP (43) ENT (3)Renal (3) 97 completed questionnaires & 0 uncompleted. 40.2% male & 59.8% female. 89% can communicate easily in English. Bengali (9), Spanish (2), Italian (1), Portuguese (1), Turkish (1) & Cantonese (1) 68% previous experience of anaesthesia.

Results 2 Somebody (65%)Nobody (35%) Nurses (27%) GPs (12.5%) Anaesthetists (12.5%) Surgeon (10%) Other (7%) 40% received a PIL 11% offered an OPA with an anaesthetist 39% wanted more information Of these:46% (22) PIL 42% (20) OPA with an anaesthetist 12.5% (6) Web page address

Discussion 1 73% received “some” information (PIL (12%) or discussion (45%) or both (42%) Compared to guidelines: 40% PIL Compared to previous data: Increased proportion had spoken to someone about their anaesthetic beforehand (35% vs 65%). The most frequent providers of information remain nurses (36% 10 vs 40%). Decreased proportion wanted more information about their anaesthetic before arriving (39% vs 59%).

Discussion 2 Can we improve on this? Yes my “Gold Standard”: 1.Each pt that wants to should see his or her anaesthetist at an OPA 2.Each pt receives a PIL at this OPA. 3.More comprehensive information should be made available on anaesthetic web page on the new Trust website.

Discussion 3 Each pt to see his or her anaesthetist as an OP. - Balanced against limited resources - At the moment targeted at higher risk - Can we offer an OPA with anaesthetist to those who want one Each pt to receive a PIL at OPA. - This can be at preadmission assessment clinic (PAC) - In-house/RCoA publication. ?budget available - Intimately linked with new Trust website An anaesthetic web page to be made available with more in depth information. - Distributing leaflets - Use audio/video formats/ local languages & larger print - Audit users who are accessing links - Relatively low cost & easy to maintain

Study limitations Unable to confirm that all patients included in the study were asked to complete the questionnaire. Unable to ensure all forms were returned. Unable to determine whether people were filling out the form correctly Unable to confirm if pts with language barriers/communication difficulties were included.

Recommendations 1 1.All pts should receive a PIL at their PAC. 2.The PIL should contain at least all information recommended by the AAGBI. 3.The PIL should be an in-house publication & intimately linked to the new Trust website 4.A new anaesthesia web page that offers more in depth information.

Recommendations 2 1.Further study to see if we can offer an OPA with an anaesthetist to each pt that wants one or identify a pt a population who we could target this offer to. 2.Further audit to evaluate how well pts with language difficulties/barriers are informed about their anaesthetic.

Acknowledgements For this study I would like to acknowledge help I received from: All the staff at the DSU who contributed to this work. I would also like to thank Dr Peter Saunders, Dr Mike Pead and Dr Simon Harrod for their assistance and discussions.