Procedures without Consent
- 0Apr 1, '13 by none the wiserHave you ever had a surgeon want to/try to do a procedure not on the consent, or actually perform a procedure not on the consent?
What other odd consent-related occurrences should I be on the look out for?
I'm still on orientation and already observed a case where the patient signed a consent that said none under "other practitioners" and the attending wanted residents assisting.
- 0Apr 7, '13 by canesdukegirl GuideYes, I actually stopped a surgeon from doing a procedure that wasn't consented for.
The pt was having an ORIF of the humerus, and was consented JUST for this procedure. Since the pt was involved in an MVA, he also had a mandible fx. One of the OMF surgeons entered the OR (he was in attendance at the red trauma when the pt came in), and attempted to do a closed mandible fx. NOT ON THE CONSENT. When I challenged him, he said that he and the pt had discussed it, and the pt was "cool with it". Uh, come again? Put in in writing, buddy.
If you are in a teaching hospital, the consent may read "Dr. XYZ and associates". This is typical for teaching hospitals since they always have residents. Good question! It means you are being thorough.
Kudos to you!
- 0Apr 7, '13 by Rose_QueenA completely unrelated procedure?
A life-threatening condition related to the consented procedure?
Yes.* We've had several cardiac surgery patients who needed a balloon pump to successfully come off cardiopulmonary bypass (as opposed to dying on the table). We've also found a few valves that needed repaired/replaced in conjunction with the scheduled open heart procedure. i.e., patient consented for aortic valve replacement. On TEE following replacement, mitral valve is no longer competent or replacing the aortic valve reveals an underlying mitral valve pathology and it needs repaired or replaced for patient to have successful surgery and postop recovery.
*Our surgical consent also contains a line in it about the surgeon doing anything extra if required to preserve life or limb. Not those exact words, just something to the effect. Before the cardiothoracic surgeons became hospital employees, they had their own consents that patients were required to sign that basically gave them carte blanche to do any necessary cardiac procedure they found necessary once in the chest. Their philosophy was it was better to fix it when they found it than let it go and have to bring the patient back in the future- if you've never seen a redo heart surgery, it can get ugly with adhesions. I've had a patient whose aorta was plastered to the sternum. We had blood checked and ready to infuse, the aortic clamp was inches from the surgeon's fingers, and we were all praying that the saw blade didn't do any damage to the aorta itself. Very tense situation.
- 0Apr 7, '13 by Rose_QueenQuote from canesdukegirlDoesn't even need to be a teaching hospital with residents. Our ortho surgeons, larger general surgeon group, and CT surgeons list either all surgeons in the group or just the group name. This is because depending on when the patient clears for surgery or when determining the schedule the night before determines what surgeon is available to do the surgery.If you are in a teaching hospital, the consent may read "Dr. XYZ and associates". This is typical for teaching hospitals since they always have residents.
- 0Apr 10, '13 by Rose_QueenOkay, I have to change my previous answer to yes. We've had a few open heart surgery patients who, when we attempted foley insertion, just couldn't get it in. These patients are already anesthetized, and we must have a foley to monitor kidney function while on cardiopulmonary bypass, and the foleys we use also monitor temperature. Usually, the urologist can get the foley in (hey, I'm not pushing through that stricture/damaging the prostate- if they do, they know how to fix it), but sometimes we end up doing a full-out cysto/dilation. Once, we even had to do a suprapubic insertion (patient's heart surgery was subsequently cancelled). These cystos/foley insertions by urologist are done without consent, but are necessary for the patient's safety.