Guess what simple mistake costs your hospital $580,000 each year and can be easily rectified? 

Missing surgical procedure consent forms.

In fact, 10% of all surgical procedures are delayed due to missing consent forms, according to a recent study published in JAMA Surgery.

This is an alarmingly high percentage when you consider the fact that the one place where things have to run smoothly and be on time is the operating room (OR). One small delay can have a significant impact.

First off, it affects all the other operations scheduled for that OR. Plus, you have staff and equipment that are being paid for but aren’t being utilized because of the delay.  And — maybe worst of all — are the effects delays have on outcomes. The surgeon gets frustrated and the patient becomes more anxious, both of which put a positive surgical outcome at risk. This is especially true if medications are administered at the projected start time of a procedure — a delay may hurt the effectiveness of the medication.

All of this from one missing consent form.

 Study results

Researchers at the Johns Hopkins University School of Medicine wanted to assess the scope of this problem at their facility, and here’s what they found:

• 66% of patients were missing signed consent forms at surgery and this caused a delay for 14% of operative cases
• the missing consent forms often interfered with team rounds and resident educational activities
• on average, residents spent less time obtaining consent than did attending physicians and that disparity became more pronounced when residents obtained a patient’s consent at the last minute
• residents were often uncomfortable obtaining consent for major procedures, and
• 40% of faculty felt dissatisfied with resident consent forms, and more than two-thirds felt patients were uncomfortable with being asked for consent by residents.

So overall, missing consent forms led to delayed cases, burdensome and inadequate consent by residents, and extra work for nursing staff — not good news.

Common and costly problem

So just how costly is this common problem?

It’s estimated that OR delays from missing consent forms cost a hospital $580,000 each year. The sad reality: This doesn’t have to happen.

According to Patient Safety and Quality Healthcare (PSQH), the Department of Veterans Affairs (VA) implemented an automated informed consent software program that stores signed consent forms directly to the electronic health record 10 years ago! And thanks to the software program, misplaced and lost consent forms have significantly decreased.

But the cost isn’t just financial. The Johns Hopkins researchers found that getting last minute consent in preoperative areas often leads to a misunderstanding of expected and achieved results. And this can lead to a higher probably of litigation for a hospital. When a patient expects a certain outcome because he or she misunderstood what the resident or attending physician said during the consent process, and doesn’t get it, they’re disappointed and often angry. Angry enough to sue staff and the facility.

So by employing a consent software program, hospitals can keep their ORs flowing smoothly, and spend more time with patients explaining the operations they are about to undergo and the expected outcomes.

Automated success

An example of where such technology has been employed successfully is the  Los Angeles County Department of Health Services (LACDHS). All hospitals with the LACDHS use a computerized tool to electronically generate detailed procedure-specific consent documents, which came about thanks to an assistant nursing director and a neurosurgeon who championed the idea of an automated template model, according to a PSQH article.

The LACDHS consent process standardized specific elements on every consent form issued. This way providers could customize any “unlocked” sections, such as procedure descriptions, to suit their needs, but designated risk/benefit details couldn’t  be removed.

Currently, the LACDHS system is still paper based in that providers print the consent form and have patients sign them. But rather than having non-standard, illegible handwriting, the printed templates allow a more systematic approach. And for the first time, all providers within the LACDHS complete consents the same way.

And by not having to spend time documenting what is communicated, providers have more time for patient discussion. And from a safety standpoint, there are fewer steps during which mistakes could occur.