Development of procedure-specific patient information sheets for acute abdominal surgery and validation in patients undergoing urgent cholecystectomy or appendicectomy

Prevalence and correlates of patient-centred preparatory information provision to computed tomography and magnetic resonance imaging outpatients: A cross-sectional study

OBJECTIVE

Responsiveness to information preferences is key to high-quality, patient-centred care. This study examined the top ten preparatory information items not delivered in accordance with medical imaging outpatients' preferences, and patient characteristics associated with reporting a greater number of unmet information preferences.

METHODS

Magnetic resonance imaging and computed tomography outpatients were recruited consecutively in one major public hospital waiting room. Participants self-administered a touchscreen computer questionnaire assessing their sociodemographic and scan characteristics, and unmet preferences for 33 guideline-endorsed preparatory information items.

RESULTS

Of 317 eligible patients, 280 (88%) consented to participate. Given equal rankings, the top ten unmet information preferences included 13 items which were endorsed by at least 25% of participants, and commonly related to receiving 'too little' information. One item related to the pre-scan period, seven items to the scan period and five items to the post-scan period. None of the patient characteristics examined were significantly associated with reporting a greater number of unmet information preferences.

CONCLUSION

There is room to improve responsiveness to medical imaging outpatients' preparatory information preferences. Improvements should be targeted at individuals, rather than groups defined by sociodemographic or scan characteristics.

PRACTICE IMPLICATIONS

A standardised approach to addressing individual patient's information preferences is needed.

Developing a patient information leaflet to improve information offered to patients undergoing appendicectomy

An appendicectomy is one of the most common operations performed in North Devon District Hospital (NDDH) with over 200 carried out between 2013 to 2014. Despite this, a patient information leaflet (PIL) about appendicectomy is unavailable, which is compromising standards of care and uncompliant with Trust policy.

This project aimed to establish levels of written information offered to patients undergoing an appendicectomy, develop a PIL, and assess its impact on the provision of written information using Plan-Do-Study-Act (PDSA) methodology. Case notes of patients operated on between January 2013 to October 2014 were randomly sampled at baseline. The primary outcome measure was whether written information was offered, retrospectively determined by reviewing the medical record. A PIL was then designed following a standard protocol, published on NDDH's website and distributed onto surgical wards. Posters were displayed in staff rooms to encourage use of the PIL for PDSA cycle 1. An article further promoting the PIL was written for the wards monthly newsletter and a local presentation was delivered for PDSA cycle 2. Patients views about the PIL were assessed prospectively using a questionnaire. The primary outcome was measured at 10 weeks following PDSA cycle 1 and at 5 months following PDSA cycle 2.

17% (5/30) of patients were offered written information at baseline. Following PDSA cycle 1, this rose substantially to 53% (8/15) but rates fell to 46% (7/15) following PDSA cycle 2. 89% of patients (8/9) surveyed agreed or strongly agreed that the PIL was helpful.

This project indicates that provision of written information is poor despite it being highly valued by patients. The first ever Trust appendicectomy PIL has been established which substantially improved provision of written information after 10 weeks. However, continued education of staff is essential to embed good practice over the long term.

Attitudes to consent--a national survey

PURPOSE

The medicolegal case of Chester v Afshar (October 2004) raises important questions with regard to the consent process in medicine and surgery. If consent has to involve disclosure of all serious risks, regardless of frequency, how does a surgeon ensure the thoroughness of the consent procedure and minimise the risk of such litigation? Procedure-specific consent forms (PSCFs)--detailing all serious risks--are a possible solution. The aim of our study was to establish the frequency of the use of such consent forms throughout the UK.

METHODS

A postal questionnaire of UK consultant British Association of Pediatric Surgery (BAPS) members was conducted. Members were asked if they used PSCFs for 4 commonly performed procedures in paediatric surgery: central venous access, inguinal herniotomy, orchidopexy, and pyloromyotomy.

RESULTS

The response rate was 89% (108/122). We obtained at least one response from every centre involved in paediatric surgery (38/38) in the UK. Seventy-nine percent (85/108) of respondents do not use PSCFs, 19% (21/108) do use PSCFs, and 2% (2/108) forms were returned blank. Thirty-one percent (33/108) of respondents included comments regarding PSCFs.

CONCLUSION

A medical negligence claim will succeed if the practitioner owes the patient a duty of care, there has been a breach of this duty, and that the breach caused a loss (causation). Our duty to the patient may now need to include disclosure of all risk regardless of frequency. PSCFs allow accurate and reproducible information for families about procedures. PSCFs currently have a low uptake amongst paediatric surgeons in the UK. The use of PSCFs for 4 procedures is currently under trial in our unit. It remains to be seen whether the success of further claims leads to an increase in their use nationally.