april 16, 2003
changes urged for consent before surgery
by the associated press
filed at 9:26 a.m. et
chicago (ap) -- critically ill patients often aren't asked permission before undergoing potentially risky invasive procedures, a study found.
such procedures frequently are viewed as emergencies and doctors have little time to get permission from patients who might be incapacitated or from hard-to-reach relatives, the university of chicago researchers said.
they found a simple solution
: a permission form given to patients, or relatives, when they enter an intensive-care unit instead of minutes before a procedure is done.
the form listed eight invasive procedures commonly performed in such units, including the insertion of breathing tubes and catheters, and spinal fluid collection. the form also included explanations of risks and benefits, both key in obtaining informed consent.
using the forms nearly doubled the rate of obtaining informed consent at the university's adult hospital, said researcher dr. jesse hall, uc's chief of pulmonary and critical care medicine. it allowed patients or relatives to decide about anticipated procedures while they were still-clear minded and not rushed.
the study appears in wednesday's journal of the american medical association.
routine practice at hospital intensive-care units nationwide has been to seek permission right before a major procedure is to be performed.
the new practice, which the chicago hospital intends to make routine, allows patient autonomy and fosters early communication between care providers, patients and family members, hall said.
state laws generally require informed consent but they also allow doctors to proceed without it in certain cases -- especially when treatment is considered lifesaving, said nancy foster, senior associate director of policy at the american hospital association.
improving patients' ability to ``have a voice in what care they receive and how they receive it is a great idea,'' she said. ``it sounds like one other institutions should look at.''
hall and colleagues found that in a two-month period before the advance form was used, informed consent was obtained before only 53 percent of the procedures. the consent rate increased to 90 percent in a two-month period afterward, from march 1 to april 30 last year.
reasons for not obtaining consent included the emergency nature of the procedures and lack of available relatives or other ``proxies,'' though in some cases doctors had disagreed about whether consent was needed, the study found.
abstract: informed consent process among critically ill patients