Worcestershire Acute Hospitals NHS Trust consent for surgery

Worcestershire Acute Hospitals NHS Trust launched a product to enable shared decision making and consent for medical treatment.

The product was developed in-house and took 8 years.

Situation

The standard, long-standing process for discussing and getting procedure consent was a manual one. Whilst it’s the responsibility of a senior clinician, it’s often handled by a more junior team member.

Manual consent forms, which rely on memory:

• are often incomplete
• contain acronyms and abbreviations
• sometimes miss out dates or signatures

Aspiration

Digitising consent for patients undergoing planned procedures will allow more time to review documentation, either by themselves or with their carers. This helps patients to understand the risks and benefits of the procedure before agreeing to it.

The digital service will support clinicians in shared decision making. It will help them adhere to General Medical Council guidelines which say that doctors must:

• ensure patients are aware of all material risks
• provide documentary evidence of the discussion between a competent healthcare professional for the specific procedure the patient’s considering

Solution and impact

The in-house system was upgraded and fully digitised using Wellbeing Software's eConsent.

The clinician either logs into eConsent directly or using a Patient Administration System (PAS) or Electronic Patient Record (EPR) and selects the appropriate procedures or treatments.

The clinician then completes the consent workflow either in person or at a virtual clinic.

Clinical risks and benefits are automatically populated. These are based on the individual patient and their planned procedure. They come from a pre-determined and clinically-approved library to provide standardised and relevant clinical information.

In a single-stage consent process, the correct signatures are captured and a copy of the consent form can be generated. The completed digital consent forms are sent to the PAS or EPR and relevant third-party systems.

If consent is captured as part of a multi-stage process, the consent form is emailed to the patient. Alternatively, the patient is sent a paper copy if required.

The patient then reviews the consent form and information leaflets. They can sign their digital consent form at home or attend a scheduled virtual clinic with a clinician.

When the patient arrives on the day of the procedure, the clinician uses the system to complete the confirmation stage of the consent process. The completed form can finally be sent digitally to the PAS or EPR.

Benefits for patients and carers

• Clear information about the procedure, risks, benefits and alternatives.
• The consultation focuses on the patient rather than writing out the consent form.
• The system can send notifications about an individual's competency level. This ensures that consent is obtained by people who are trained to explain the specific procedure.
• Patients receive information sooner. This means they have more time to consider options and get more information.
• Documentation can be emailed to a patient during the consultation.

Benefits for staff obtaining consent

• Reduces the time staff spend filling out forms.
• Staff have a checklist to guide each consultation. This helps them to identify risks, benefits and alternatives for each procedure performed in the different departments of the Trust.
• The links with the patient administration portal are well developed. This means the patient's individual information can be accessed quickly during the consultation.

Benefits for the organisation

• There are fewer complaints.
• Standardising the approach to litigation enables clinical practices to be audited.
• Patient information leaflets and consent forms cost less to produce.
• Information and processes across the Trust’s multiple sites and departments are standardised.
• The service facilitates progress towards paperless status.
• The service helps the organisation to comply with risk management standards.
• The organisation now has a document management system for patient information leaflets. Archived consent and information forms used during the consultation can be accessed.
• Complete legible documentation is available to support the patient’s admission.
• Based on 30,000 procedures per year, the Trust will save around 2,500 clinical hours completing paper consent forms. This time could be used to improve the quality of shared decision making discussions or to transform the service.
• The Trust will stop using paper-based consent forms which cost around £20,000 a year.
• The Trust can save around £8,000 on scanning costs for handwritten consent.

Annual consent audits for surgical procedures also showed substantial improvements.

Before eConsent was introduced:

• 49% of medical notes had documented evidence to show that the benefits and risks of a procedure have been discussed with the patient
• 69% of consent forms had the date that the consent was obtained and recorded
• 63% recorded the patient's NHS number

All of these figures improved to 100% when the digitised system was introduced.

In addition, eConsent has reduced unreadable items, such as the name of the procedure, from 25% to 0%. This was also the case with the 21% of forms that were completed by a non-competent healthcare professional.

Functionality

eConsent is a cloud-hosted service that digitises the consent to treatment process across the Trust.

The solution helps dynamically create 4 nationally recognised consent forms.

It’s pre-populated with individual patient demographics and given to the patient when a procedure or treatment is proposed. Relevant leaflets are also given to the patient during the discussion. This improves the quality and process of the documentation and the patient experience.

To facilitate remote consultations, eConsent has the option to send patients a secure link to their consent form. Sensitive information like details about their procedure requires security details to be entered before it can be accessed.

Capabilities

All aspects of consent for treatment. This includes medical treatments such as oncology.

eConsent is designed to work with existing clinical systems to enable a cost-effective visualisation of health documents. It comes with many digital features to support the teams with consent process.

Scope

The service can be used in all areas of the organisation where there is access to the internet. This also includes community-based clinics.

The service can be used by patients on-site or remotely using their own digital devices.

Key learning points

Clinical teams should agree to use the national eConsent standard database. Where agreed procedures do not exist within eConsent, changes should be agreed by exception.

eConsent includes the option to capture signatures digitally using an appropriate input device like a:

• touchscreen stylus
• mouse
• graphics tablet with a signature pad

Most organisations chose to use tablets.

Active directory integration can be set up between the Trust’s active directory service and eConsent. This means the Trust can manage access to eConsent. An eConsent system administrator is required for this.

Key quotes

“The solution is a brilliant development which greatly facilitates and accurately documents the shared decision-making process which is a crucial element of patient care.”

Steve Pandey, Consultant Colorectal Surgeon, Worcestershire Acute Hospitals NHS Trust

“The system is easy to use, clear documentation, ready access, ability to share accurate details with my supporting family - greatly appreciated the remote access, given current issues in the hospital.” 

John, patient

“It’s a game-changer in reduction of precious wasted peri-operative time. Crucial given the need to improve theatre productivity.”

Julie Briggs, Deputy Divisional Director of Operations - Surgery, Worcestershire Acute Hospitals NHS Trust

“Valued asset in dealing with any patient concerns over treatment. All clinicians should use - all of the time!”

Jane Clavey, Legal Practitioner, Worcestershire Acute Hospitals NHS Trust

Key contact

Stephen Lake, Consultant Surgeon, Worcestershire Acute NHS Trust

stephen.lake1@nhs.net