1. 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

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

3. 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?...

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

5. Decision making is a shared responsibility… Was conservative management discussed with the patient? yes 53.9% no 12496.1% insufficient data 13

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

7. Grade of clinician obtaining consent for Rxn% Consultant21974.2 Associate specialist/Staff grade2<1 Trainee with CCT72.4 Senior Specialist Trainee6421.7 Junior Specialist Trainee1<1 Basic Grade1<1 other1<1 subtotal295 n/a14 total309

8. 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

9. Source of consentn% Patient20568.8 Form 4: patient unable to give consent 9331.2 subtotal298 n/k6 n/a5 total309

10. Source of consent Consent process was adequate DeficienciessubtotalInsufficient data/ no form total patient13124 (15.5%) 15550205 Form 4526 (10.3%) 583593 subtotal1833021385298 n/k40426 n/a11205 total1883121990309 Was the consent process satisfactory?

11. 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’...