1. An Audit On Informed Consent Fulfilment Process
Mohd Afiq Mohd Slim
Feargal Cadden
Michael Mullan
Seamus Dolan

2. Background Complex process When not to give Patient wish Necessity
Knowing will cause more harm

3. Montgomery Ruling March 2015
Bolam test is out!
The Test of Materiality
“reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments”
‘Material risk’
“A risk to which a reasonable person in the patient’s position would be likely to attach significance or a risk that a doctor knowns, or should reasonably know”
Time….time….time!
“even those less skill or inclination for communication will be obliged to pause and engage in the discussion which the law requires”
What is a bolum test: if a doctor conduct is supported by a responsible body/medical body opinion, then that option is valid
Problem with Montgomery here
1. Need to gauge patient’s ‘importance’, what is important to them might not be important to us eg bus drive or lorry driver post perianal abscess I&D, cannot sit, cannot drive, cannot earn OR young beautiful lady, bikini model, have umbilical hernia now belly button gone post-op

4. Aim
To assess the amount of information given to the patient for a valid informed consent process

5. Standard
Royal College of Surgeons of England, Good Surgical Practice 2014

6. Methods 1-1 survey Only elective cases Aug-Sep All consultants
Likert scales for rating questions
Only elective cases
Cholecystectomy
Hernia
Inguinal
Umbilical

7. Risk Explanation Score
Results: Overview
Type of Operation
Sample Size (n)
Survey score (%)
Risk Explanation Score
Cholecystectomy 10
68.43
9.2
Hernia
58.14
8.7
N asked=21 patients, 1 say no, so only 20
Overall survey score=63.29%
Overall risk=8.95 (likert, 10 good, 1 bad)

8. RCS England Standard=73.57
Chole=72.85%
Hernia=74.29%

9. Extra Part here=53%
Chole=64%
Hernia=42%
Sign at OPD-1 chole, 4 hernia,
Hernia don’t have information leaflet
Majority got consented at OPD, no copy of form given, majority sign on admission

10. Conclusion Suggestions We are good but we can be better!
Information leaflet for
Inguinal hernia
Umbilical hernia
Continue consenting in OPD
Give a copy of consent form to patient
Impact of surgery on patient’s life
To inform patient regarding other possible surgeons