925 Consent for Carpal Tunnel Decompression and Trigger Finger Release – Are We Following Standards? a Closed Loop Audit
S Roberts-Walsh, I Minty, S Tse, A White, A Davy- Surgery
Abstract
Aim
Every surgeon has a legal and ethical duty to ensure the consent process is comprehensive and documented. The RCS and GMC have provided guidance on this. Our aim was to assess current practice of consent in two common hand surgical procedures - carpal tunnel decompression (CTD) and trigger finger release (TFR). We evaluated the effect of departmental education following a previous audit of standards.
Method
A retrospective review was conducted on patients who underwent CTD or TFR during the three-month period of September–November 2021. Auditing against GMC and RCS standards, medical records were assessed for documentation of risks of procedure, presentation of alternative options to surgery, and whether risks on the consent form were consistent with pre-operative clinic discussions. Following re-education of surgeons on the consent process, the audit loop was closed with re-evaluation between September–November 2022.
Results
57 patients were included in the first audit cycle and 50 patients in the second. Prior to re-education, 88% of patients had risks explained and 61% had alternatives discussed and documented in clinic. Post-intervention, both improved to 100%. 79% (vs 66% before) had “new” risks on the consent form not documented on the clinic letter. However only 3.5% of cases in the first cycle and 2% in the second cycle had identical risks documented in the consent form and clinic notes.
Conclusions
Education on the gold-standard consenting process had a positive impact on compliance. We also recommend departmental standardisation on risks and benefits for common procedures which can be supplemented by patient-focused literature.