A Surgeon’s Perspective on Clinical Digital Patient Consent
During this year’s HTN Digital Week, Mr. Stephen Lake FRCS, Consultant General Surgeon at Worcestershire Acute Hospitals NHS Trust and Wellbeing’s Chief Marketing Officer, Patrick Chapman held a live webinar to discuss the demonstrable benefits of full adoption of digital consent over paper consent to the NHS.
The session specifically outlined how the deployment of digital consent against paper-based consent doesn’t only save money and time, but more fundamentally hugely reduces the risk of error, omission or misunderstanding during that key clinician and patient consultation.
So, what are the risks of NOT going digital?
Such risks cover organisational, clinical, administrative and patient misunderstanding impacts due to a confusing or incomplete patient consent process. There’s also the real risk of human error during a paper-driven consent, which may not just delay a planned procedure, but actually lead to a procedure being cancelled, obviously frustrating for the patient, but also for the hospital and which also has cost implications to the hospital in question too. Mr. Lake said:
“I have heard from around the country where too many times, operations have been cancelled because the paperwork hasn’t been in place, and this can be a disaster for patients and the organisation.”
Referencing the recent BBC Freedom of Information report highlighting not only the c.£4billion+ legal fees cost to the NHS but the c.£89billion of litigation costs in the system around clinical error and negligence, Mr. Lake evidenced some of this would be avoidable with a robust and auditable digital consent system in place.
Quoting official findings from GIRFT (Get It Right First Time) 2018 reports on Urology as just one specialty example, litigation regularly directly related to a ‘failure to warn’ or a lack of fully informed consent. In particular:
- Most common causes for claims: ‘judgement/timing’ (739 claims, 51.1%), ‘interpretation of results/clinical picture’ (324 claims, 22.4%), ‘unsatisfactory outcome to surgery’ (200 claims, 13.8%) and ‘failure to warn/informed consent’ (113 claims, 7.8%)
- The impact of informed consent on surgical claims is more significant than the 113 claims directly identified
- Lack of fully informed consent has played a role in many of the claims which were attributed to ‘unsatisfactory outcome of surgery’
Stephen asserted much of this is ‘clearly avoidable’ through the use of an appropriate consent policy; with many other risks mitigated through a digital surgical consent process.
What are the core benefits of deploying a digital system?
First and foremost, the move to a digital system results in ‘significant consent process improvements’ that are compliant with mandated standards from the CQC NHSLA and Royal Colleges. As Mr. Lake made clear in his professional opinion:
“Digital consent is revolutionising the consent to surgical procedure treatment process.”
Other improvements include reduced administrative time, which allows clinicians to consult with more patients. In addition to directly reducing the risk of surgical litigation cases, digital systems reduce costs though decreased clinic overheads, cancelled theatre slots impact, and direct administration costs. Importantly also, the digitisation process is fully in line with national initiatives such as NHS Digital Domain G – ‘Paper free at the Point of Care’.
Mr. Lake also outline the evolution of eConsent, developed collaboratively and in partnership with Wellbeing. As he stated:
“I wanted to lose the handwritten consent and for the forms to conform to necessary standardisation and with the ability to audit if required. Partnering with Wellbeing has ensured this and meant we’ve been able to extend and enhance those capabilities. eConsent is adaptable to different environments – you can use it in consultation, on the wards, and in so many different scenarios. It standardises and safeguards compliance within mandated standards.”