Digital consent to treatment in North West London
Consent to treatment or surgical consent is usually given on the day of treatment. With the support of a clinician, the patient reviews and signs a printed consent form and a carbon copy at the bedside.
Over the past few years, medico-legal case law has driven best practice recommendations. There has been an increasing understanding that both the timing and the content of consent conversations need to change. Consent conversations need to:
- happen earlier
- be more personalised
- be easier for patients to engage with to achieve shared and informed decision
Chelsea and Westminster Hospitals NHS Foundation Trust (CW) and Imperial College Healthcare NHS Trust (ICHT) introduced the digital consent pilot to support existing pathways and shift to a better process to get consent.
The consent process has been an issue for a number of different groups across both trusts.
The paper consent process was frustrating for clinicians.
Clinicians found the paper consent process frustrating because:
- completing blank template forms took valuable time away from consent conversations
- remembering the relevant risks for every procedure was difficult and made the process risky
- lost consent forms caused theatre delays which was stressful
Patients reported that the consent process was disempowering. The healthcare team often share lots of challenging information:
- in a short period of time
- right before the operation starts
This makes effective shared decision making harder.
For organisations, consent practices are getting more expensive because of the medico-legal risk and paper-based costs and logistics.
Omitting information and losing consent forms have increased consent-related medico-legal costs. These now cost NHS England more than £60 million a year.
The Trusts first considered complex paper logistics to manage the consent process. This was because there was an increasing amount of cross-site and regional work. The Trusts also wanted to maintain remote pre-surgical pathways.
The Trusts wanted to introduce digital consent to replace the existing paper consent process. They wanted to:
- enable remote pre-surgical pathways so the consent process happens earlier in the patient journey
- remove the need for complex paper logistics and costs
- reduce medico-legal risk by using evidence-based, personalised, accessible information to support consent conversations
- reduce day-of-surgery cancellations and delays to improve efficiency
- improve the consent experience for patients and clinicians
Solution and impact
Having considered the options on the market, the Trusts introduced Concentric's digital consent application at ICHT in April 2020 and July 2020 at CW.
The Trusts introduced the process in phases across the 2 organisations. This included elective and emergency treatment pathways for surgical, radiology and oncology specialties.
All types of operations, procedures, and treatments use the solution, this includes:
- outpatient local anaesthetic treatments
- complex multi-procedure operations
- chemotherapy treatments
- biological medicines
Concentric sends personalised digital consent forms to the vast majority of patients across both organisations. The patients receive an SMS or email ahead of the day of surgery, alongside or following a virtual or face-to-face consent consultation. More patients had a mobile number than an email address on the Trusts’ systems.
Introducing Concentric's digital consent has been a success across the 2 organisations. There was positive feedback and support for use of digital consent by default across patient and clinician groups.
Remote consent pathways are supporting recovery from the pandemic and reducing theatre cancellations. Clinicians have more confidence in the quality of the consent process that they deliver. The Trusts expect that this will reduce medico-legal costs in the medium term.
An evaluation demonstrated an increase in shared decision making (SDM) quality across all SDM domains. It also showed a shift away from on-the-day consent.
The Trusts have received 2,500 patient feedback surveys so far. 91% of patients gave their experience of the Concentric consent process 4 or 5 stars out of 5.
More work is being done to understand:
- the impact on both day-of-surgery delays and cancellations
- the shift it has enabled to remote pre-surgical pathways
It’s estimated that the solution reduces day-of-surgery delays and cancellations by around 10%.
- is a web application which is now used across a number of NHS Trusts
- has content for all specialties and consent form types
- integrates with trust systems, for example, patient demographics and document storage systems
- can share information with the patient via either SMS or email
Concentric digital consent is successful because:
- any device can access it from anywhere
- it has the ability to easily generate complex combined procedures
- it has the flexibility to personalise the consent information for each patient
- it supports remote consent where appropriate
Patients at home and in clinical settings use Concentric.
During the first year, 13,250 patients completed consent through Concentric across the 2 organisations. Of these, around:
- 60% were on the day of treatment
- 20% were in face-to-face outpatient clinics
- 20% were following a remote consultation
Clinicians reviews the completed consent forms within the main electronic health record.
Key learning points
- There was confusion where there was a mixture of paper and digital consent, theatre teams were unsure of where to find the consent form.
- Departments, their associated wards and theatre teams found it easier to transition to digital consent when the Trusts introduced it as the default mechanism for consent across the department.
- An internal project manager was critical to success. They act as a conduit between the supplier and the clinical teams to drive adoption across the organisation.
- Costs for paper, scanning, storage and legal support come out of different budgets in the organisation. Bringing together the different elements to deliver a cost neutral or cost saving business case takes time and should be started early.
“Since using digital consent, I find that my patients are more informed about their surgery and have information to read back on without having to struggle with my surgeon’s handwriting.”
Ahmad Aziz, Consultant Ophthalmologist and Oculoplastic Surgeon, ICHT
“Without innovations such as Concentric, the delivery of many services would have been nearly impossible since March 2020 and it is clear that digital technology has a huge role to play in the future of improving patient care, staff wellbeing, and driving organisational recovery post-pandemic.”
Phoebe Allen, Project lead for digital consent, CW
Find out more
Dr Grant McQueen, Quality Improvement Manager, Chelsea and Westminster Hospital NHS Foundation Trust
Mr Ahmad Aziz, Consultant Ophthalmologist and Clinical lead for digital consent, ICHT
Dr Dafydd Loughran, CEO, Concentric Health
These case studies summarise user and patient experiences with digital solutions along the relevant care pathway. Unless expressly stated otherwise, the apps and digital tools referenced are not supplied, distributed or endorsed by NHS England or the Department of Health and Social Care and such parties are not liable for any injury, loss or damage arising from their use.
All playbook case studies have either passed, or are currently undergoing the Digital Technology Assessment Criteria (DTAC) assessment.
Please note the full legal disclaimer: NHS England playbook disclaimer