Mohamed Ahmed, Abdalla MohammedElhassan
Department of Orthopaedics, Gezira Centre for Orthopedic Surgery and Traumatology, Wad Madani, SDN.
Cureus. 2024 Jul 21;16(7):e65043. doi: 10.7759/cureus.65043. eCollection 2024 Jul.
An essential component of medical ethics and practice is informed consent. The General Medical Council (GMC) and the Royal College of Surgeons of England (RCS) provide guidelines for obtaining valid consent. Failing to obtain sufficient or valid consent can have legal consequences.
Over a period of two and a half months, from March 12 to May 28, 2022, a retrospective cross-sectional study was conducted to evaluate consenting practices for neck of femur fracture surgeries. A total of 88 patient consent forms were reviewed. The standard consent forms utilized in this study were those endorsed by the British Orthopaedics Association (BOA) and were based on the guidelines provided by the RCS and the GMC.
Resident surgical trainees and medical officers obtained the majority of the consents, 31 (35.22%) and 49 (55.68%), respectively. The most frequently reported risks included infection, blood clots (deep vein thrombosis and pulmonary embolism), bleeding, and wound complications. Neurovascular injury was not mentioned in 75 (85.33%) consent forms. Additionally, hip stiffness, prosthetic dislocation, death, and leg length discrepancy were not discussed with any of the patients. Additionally, we observed that the diagnosis or reason for surgery was mentioned in only 60 (68.18%) consent forms. Furthermore, none of the forms specified the intended benefits, the necessity for a blood transfusion, or the patient identification details.
Our study revealed inadequate documentation of surgical risks in patient consent forms for neck of femur fracture surgeries, with orthopaedic-specific risks often overlooked. This issue likely results from insufficient orthopaedic training among the medical officers and junior resident trainees responsible for obtaining consent. We recommend induction teaching sessions to improve their understanding of standard consenting practices and associated risks, along with implementing patient identification stickers.
知情同意是医学伦理和实践的重要组成部分。英国医学总会（GMC）和英格兰皇家外科医学院（RCS）提供了获得有效同意的指导方针。未能获得充分或有效的同意可能会产生法律后果。
在2022年3月12日至5月28日的两个半月时间里，进行了一项回顾性横断面研究，以评估股骨颈骨折手术的同意程序。共审查了88份患者同意书。本研究使用的标准同意书是由英国骨科协会（BOA）认可的，并且基于RCS和GMC提供的指导方针。
住院外科实习生和医务人员获得了大部分同意，分别为31份（35.22%）和49份（55.68%）。最常报告的风险包括感染、血栓（深静脉血栓形成和肺栓塞）、出血和伤口并发症。75份（85.33%）同意书中未提及神经血管损伤。此外，未与任何患者讨论髋关节僵硬、假体脱位、死亡和腿长差异。此外，我们观察到只有60份（68.18%）同意书中提到了手术诊断或原因。此外，没有一份表格明确说明了预期益处、输血必要性或患者识别细节。
我们的研究表明，股骨颈骨折手术患者同意书中手术风险的记录不充分，骨科特有的风险经常被忽视。这个问题可能是由于负责获取同意的医务人员和初级住院实习生骨科培训不足造成的。我们建议开展入职培训课程，以提高他们对标准同意程序及相关风险的理解，并实施患者识别标签。
