Cwm Taf Morgannwg University Health Board, UK.
Aneurin Bevan University Health Board, UK.
Ann R Coll Surg Engl. 2023 Mar;105(3):278-282. doi: 10.1308/rcsann.2022.0100. Epub 2022 Oct 19.
Since the Montgomery ruling in 2015 surgeons have been tasked with identifying material risk when taking informed consent. Despite this, there has been limited uptake of technological aids to supplement the consent process although such aids are shown to improve patient knowledge and satisfaction. ConsentPLUS is a free-to-access website with bite-sized educational videos designed to clearly explain lower limb arthroplasty procedures to patients and aid their consent.
The authors performed a prospective cost-consequence analysis, outlining any costs associated with the intervention and any quantitative or qualitative impacts the intervention may have on patients.
A total of 3,143 consecutive patients were identified who were undergoing total knee or hip replacement in 25 elective NHS orthopaedic units. The total cost of development and projected 10-year running fees for ConsentPLUS total £75,000. Health Foundation support means the service is free-to-access for centres throughout the UK. Mean exposure time per patient was 10min 29s, equivalent to £185,437 of additional contact time according to the National Tariff. Mean clinic time was reduced by 17min owing to the earlier identification of material risk. Patient knowledge on pre- and post-video quizzes increased from 7.01 to 9.08 following eLearning (paired -test = 0.998). The process had an overall satisfaction rate of 97%.
Educational eLearning videos are an accessible and digestible way to supplement the consent process. This enables earlier identification of material risk in clinics owing to improved patient knowledge, leading to increased patient satisfaction with arthroplasty consenting.
自 2015 年蒙哥马利案裁决以来，外科医生的任务是在获得知情同意时识别实质性风险。尽管如此，尽管技术辅助工具可以提高患者的知识和满意度，但很少有外科医生采用这些工具来补充同意过程。ConsentPLUS 是一个免费访问的网站，提供了一系列短视频，旨在向患者清晰地解释下肢关节置换手术，并帮助他们获得知情同意。
作者进行了一项前瞻性成本效益分析，概述了干预措施相关的任何成本，以及干预措施可能对患者产生的任何定量或定性影响。
共确定了 3143 名连续患者，他们在 25 个 NHS 骨科单位接受全膝关节或髋关节置换术。ConsentPLUS 的总开发成本和预计 10 年的运行费用为 75000 英镑。健康基金会的支持意味着该服务对英国各地的中心都是免费的。每位患者的平均暴露时间为 10 分 29 秒，根据国家关税，相当于额外接触时间 185437 英镑。由于更早地发现了实质性风险，平均门诊时间减少了 17 分钟。由于电子学习，患者在预诊和视频后测验中的知识从 7.01 增加到 9.08（配对检验=0.998）。该过程的总体满意度为 97%。
教育性电子学习视频是补充同意过程的一种便捷、易于理解的方式。这使得由于患者知识的提高而更早地在诊所中识别实质性风险，从而提高了患者对关节置换同意的满意度。
