How Informed Is Your Informed Consent: Evaluating Differences Between Resident and Attending Obtained Consents for Cholecystectomy. 2022

Kathleen E Singer, and Jennifer E Baker, and Nora C Elson, and Taylor E Wallen, and Ann Salvator, and Ralph C Quillin, and Jeffrey J Sussman, and Amy T Makley, and Michael D Goodman
Department of General Surgery, University of Cincinnati, Cincinnati, Ohio.

There is considerable variability in surgeons' approach to write and obtain informed consent for surgery, particularly among resident trainees. We analyzed differences in procedures and complications described in documented surgical consents for cholecystectomy between residents and attendings. We hypothesized that attending consents would describe more comprehensive procedures and complications than those done by residents. This is a retrospective analysis of 334 patients who underwent cholecystectomy. Charts were queried for demographics, surgical approach, whether the consent was completed electronically, and which provider completed the consent. Specifically, consents were evaluated for inclusion of possible conversion to open procedure, intraoperative cholangiogram, bile duct injury, injury to nearby structures, reoperation, bile leak, as well as if the consent matched the actual procedure performed. This study was conducted at an accredited general surgery training program at an academic tertiary care center in the Midwest. This was a review of 334 patients who underwent cholecystectomy over a 1 year period. Of all documented consents analyzed, 153 (47%) specifically included possible intraoperative cholangiogram, 156 (47%) included bile duct injury, 76 (23%) included injury to nearby structures, 22 (7%) included reoperation, and 62 (19%) included bile leak. In comparing residents and attendings, residents were more likely to consent for bile duct injury (p = 0.002), possible intraoperative cholangiogram (p = 0.0007), injury to nearby structures (p < 0.0001), reoperation (p < 0.0001), and bile leak (p < 0.0001). Significant variation exists between documentation between resident and attending cholecystectomy consents, with residents including more complications than attendings on their consent forms. These data suggest that experience alone does not predict content of written consents, particularly for common ambulatory procedures. Education regarding the purpose of informed consent and what should be included in one may lead to a reduction in variability between providers.

UI MeSH Term Description Entries
D007258 Informed Consent Voluntary authorization, by a patient or research subject, with full comprehension of the risks involved, for diagnostic or investigative procedures, and for medical and surgical treatment. Consent, Informed
D002763 Cholecystectomy Surgical removal of the GALLBLADDER. Cholecystectomies
D004282 Documentation Systematic organization, storage, retrieval, and dissemination of specialized information, especially of a scientific or technical nature (From ALA Glossary of Library and Information Science, 1983). It often involves authenticating or validating information. Documentations
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000007 Abdominal Injuries General or unspecified injuries involving organs in the abdominal cavity. Injuries, Abdominal,Abdominal Injury,Injury, Abdominal
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D012308 Risk Management The process of minimizing risk to an organization by developing systems to identify and analyze potential hazards to prevent accidents, injuries, and other adverse occurrences, and by attempting to handle events and incidents which do occur in such a manner that their effect and cost are minimized. Effective risk management has its greatest benefits in application to insurance in order to avert or minimize financial liability. (From Slee & Slee: Health care terms, 2d ed) Hospital Incident Reporting,Incident Reporting, Hospital,Hospital Incident Reportings,Incident Reporting,Incident Reportings, Hospital,Management, Risks,Reporting, Hospital Incident,Reportings, Hospital Risk,Voluntary Patient Safety Event Reporting,Hospital Risk Reporting,Hospital Risk Reportings,Incident Reportings,Management, Risk,Reporting, Hospital Risk,Reporting, Incident,Reportings, Hospital Incident,Reportings, Incident,Risk Reporting, Hospital,Risk Reportings, Hospital,Risks Management

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