Jt Comm J Qual Patient Saf. 2024 Jul;50(7):528-532. doi: 10.1016/j.jcjq.2024.03.005. Epub 2024 Mar 10.
Although access to a professional medical interpreter is federally mandated, surgeons report underutilization during informed consent. Improvement requires understanding the extent of the lapses. Adoption of electronic consent (eConsent) has been associated with improvements in documentation and identification of practice improvement opportunities. The authors evaluated the impact of the transition from paper to eConsent on language-concordant surgical consent delivery for patients with limited English proficiency (LEP).
The study period (February 8, 2023, to June 14, 2023) corresponds to the period immediately following the institutional adoption of eConsents. Inclusion criteria included age > 18 years, documented preferred language other than English, and self-signed eConsent form. The authors assessed documentation of language-concordant interpreter-mediated verbal consent discussion and delivery of the written surgical consent form in a language-concordant template. Performance was compared to a preimplementation baseline derived from monthly random audits of paper consents between January and December 2022.
A total of 1,016 eConsent encounters for patients with LEP were included, with patients speaking 49 different languages, most commonly Spanish (46.5%), Chinese (22.1%), and Russian (6.8%). After the implementation of eConsent, overall documentation of language-concordant interpreter-mediated consents increased from 56.9% to 83.9% (p < 0.001), although there was variation between surgical services and between languages, suggesting that there is still likely room for improvement. Most patients (94.1%) whose preferred language had an associated translated written consent template (Spanish, Chinese, Russian, Arabic), received a language-concordant written consent.
The transition to eConsent was associated with improved documentation of language-concordant informed consent in surgery, both in terms of providing written materials in the patient's preferred language and in the documentation of interpreter use, and allowed for the identification of areas to target for practice improvement with interpreter use.
尽管获得专业医学翻译是联邦政府的要求，但外科医生报告在知情同意过程中未充分利用翻译服务。要改善这种情况，就需要了解疏忽的程度。采用电子知情同意（eConsent）已与文档记录的改善和发现实践改进机会相关联。作者评估了从纸质知情同意过渡到电子知情同意对英语水平有限（LEP）患者进行语言一致的手术知情同意的影响。
研究期间（2023 年 2 月 8 日至 2023 年 6 月 14 日）与机构采用电子知情同意书的时间相对应。纳入标准包括年龄大于 18 岁、记录的首选语言非英语，以及自行签署电子知情同意书。作者评估了记录语言一致的口译员介导的口头同意讨论和以语言一致的模板交付书面手术同意书的情况。表现与 2022 年 1 月至 12 月期间每月随机审核纸质同意书的实施前基线进行比较。
共纳入 1016 例 LEP 患者的电子知情同意书，患者使用 49 种不同的语言，最常见的是西班牙语（46.5%）、中文（22.1%）和俄语（6.8%）。在实施电子知情同意书后，语言一致的口译员介导同意的总体记录从 56.9%增加到 83.9%（p<0.001），尽管在手术服务之间和语言之间存在差异，表明仍有改进的空间。大多数首选语言有翻译书面同意书模板的患者（西班牙语、中文、俄语、阿拉伯语）获得了语言一致的书面同意书。
从纸质知情同意书过渡到电子知情同意书与提高手术中语言一致的知情同意的文档记录有关，包括提供患者首选语言的书面材料和口译员使用的记录，并允许确定需要改进的领域，以提高口译员的使用。
