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三级转诊中心急诊环境下骨科创伤的知情书面同意书:闭环审核

Informed Written Consent for Orthopaedic Trauma in the Emergency Setting at a Tertiary Referral Centre: A Closed-Loop Audit.

作者信息

Davey Martin S, Davey Matthew G, Mohan Kunal, O'Driscoll Conor S, Murphy Colin G

机构信息

Trauma and Orthopaedics, Galway University Hospitals, Galway, IRL.

出版信息

Cureus. 2021 Nov 11;13(11):e19460. doi: 10.7759/cureus.19460. eCollection 2021 Nov.

Abstract

Introduction The purpose of this investigation was to perform an audit of the standards of consent forms in which patients sign prior to operative intervention for orthopaedic trauma in an emergency setting in our institution, with comparison to the standards, as set by the . If required, the investigator aimed to close the loop in this audit by educating orthopaedic surgeons on the necessary standards of obtaining written consent for orthopaedic trauma. Methods Following being granted approval by our institutional audit committee, a pre-intervention cycle was performed to assess the quality of consent obtained in written format using electronic patient records in consecutive patients over a four-week period. Following the analysis of this data, an education session was provided for all orthopaedic doctors responsible for obtaining informed written consent from patients who are planned to undergo operative management of a soft tissue or bony injury by the trauma and orthopaedic service in the emergency setting. Thereafter, a post-intervention cycle was performed with subsequent descriptive analysis using the GraphPad software. Results In the pre-intervention audit cycle, all included (n = 107) consent forms (100%) correctly included the patient's name, date of birth (DOB) and institutional board number (BN). However, only 79 consent forms (74.5%) were completed without using abbreviations or acronyms of any kind, whilst 81 consent forms (76.4%) were completed without correctly stating the side or site of the planned intervention. In the post-intervention cycle, all included (n = 40) consent forms (100%) correctly included the patient's name, DOB and institutional BN. Additionally, a total of 37 consent forms (92.5%) were correctly completed without using abbreviations or acronyms of any kind (74.5% versus 92.5%, p = 0.02). Furthermore, a total of 39 consent forms (97.5%) were completed correctly stating the side or site of the planned intervention (76.4% versus 97.5%, p = 0.0015). Conclusion This closed-loop audit found that the quality of informed consent obtained by orthopaedic surgeons in the emergency setting might potentially be significantly improved with at least one virtual education session. Such simple education sessions may potentially improve the documentation of the planned potential operative intervention by orthopaedic surgeons for cases of orthopaedic trauma to ensure patient safety is optimised. As the turnover of non-consultant hospital doctors is high in university teaching hospitals, regular education sessions on such topics may introduce a cultural shift in maintaining high standards when marking and consenting patients in the emergency setting.

摘要

引言 本调查的目的是对我院急诊环境下骨科创伤手术干预前患者签署的同意书标准进行审核,并与[具体机构]制定的标准进行比较。如有需要,研究者旨在通过对骨科医生进行关于获取骨科创伤书面同意书的必要标准的培训,来完善此次审核。方法 在获得我院机构审核委员会批准后,进行了一个干预前周期,使用电子病历对连续四周的患者以书面形式获得的同意书质量进行评估。在对这些数据进行分析之后,为所有负责从计划在急诊环境下接受创伤与骨科服务的软组织或骨损伤手术治疗的患者处获取知情书面同意书的骨科医生提供了一次培训课程。此后,使用GraphPad软件进行后续描述性分析,开展了一个干预后周期。结果 在干预前审核周期中,所有纳入的(n = 107)同意书(100%)均正确包含患者姓名、出生日期(DOB)和机构编号(BN)。然而,只有79份同意书(74.5%)在填写时未使用任何缩写或首字母缩略词,而81份同意书(76.4%)在填写时未正确注明计划干预的部位或位置。在干预后周期中,所有纳入的(n = 40)同意书(100%)均正确包含患者姓名、DOB和机构BN。此外,共有37份同意书(92.5%)在填写时未使用任何缩写或首字母缩略词(74.5%对92.5%,p = 0.02)。此外,共有39份同意书(97.5%)在填写时正确注明了计划干预的部位或位置(76.4%对97.5%,p = 0.0015)。结论 此次闭环审核发现,通过至少一次虚拟培训课程,急诊环境下骨科医生获取的知情同意书质量可能会显著提高。这种简单的培训课程可能会改善骨科医生对骨科创伤病例计划的潜在手术干预的记录,以确保患者安全得到优化。由于大学教学医院中非顾问医院医生的流动率较高,定期开展此类主题的培训课程可能会在急诊环境下为患者做标记和获取同意书时,在维持高标准方面带来文化转变。

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