scholarly journals 108 Neck of Femur Fractures: Streamlined Approach to Improve Consenting Practices

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Brown ◽  
A Gaukroger ◽  
M Raza ◽  
R Sturley ◽  
M Arnander
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
General Medical Council ◽  
Mean Value ◽  
Medical Council ◽  
The Novel ◽  
Neck Of Femur ◽  
Consent Forms ◽  
Femur Fractures ◽  
Operative Fixation

Abstract Aim Neck of femur fractures (NOFs) are synonymous with frailty, and successful outcomes are achieved with operative fixation. The United Kingdom’s General Medical Council guidance governing consent highlights the importance of thorough pre-operative discussion of risk with the patient. We aimed to audit consenting practices in NOF patients within our unit against the British Orthopaedic Association’s (BOA) criteria, with the addition of delirium as a risk factor. Method In cycle one all operatively managed NOFs over a two-month period in October-November 2019 were retrospectively reviewed. Consent forms 1 (CF1) and 4 (CF4) were assessed against BOA-endorsed criteria. Our intervention included a standardised sticker detailing 14 important risks was introduced and a departmental seminar on delirium. A second cycle was undertaken from August-October 2020 to close the audit loop Results No consent form documented all BOA-approved risk factors in cycle one (N = 35). Of cycle two’s 35 patients, 70.8% CF1 were completed using the novel sticker. All of these had 100% BOA-approved risk documentation. Consent forms without the sticker in cycle two documented 9/14 risks (mean value). No CF4 had any risks documented in either cycle. Delirium was documented in 51% in total and in 75% patients with CF1. Delirium documentation improved from 2.9% in cycle one to 51.4% in cycle two. Conclusions Clear lapses in operative consenting processes were identified, especially regarding delirium and CF4 documentation. The introduction of a novel consent sticker drastically improved compliance with BOA guidance for CF1. Recognition and departmental education regarding delirium significantly reduced incidence between cycles.

scholarly journals An audit cycle of consent form completion: A useful tool to improve junior doctor training

2016 ◽  
Vol 49 (01) ◽  
pp. 72-75 ◽  
Author(s):  
Catherine Leng ◽  
Kavita Sharma
Keyword(s):  
Junior Doctor ◽  
General Medical Council ◽  
Consent Form ◽  
Junior Doctors ◽  
Medical Council ◽  
Emergency Setting ◽  
Consent Forms ◽  
Surgical Practice ◽  
Audit Cycle ◽  
Practice Methods

ABSTRACT Background: Consent for surgical procedures is an essential part of the patient's pathway. Junior doctors are often expected to do this, especially in the emergency setting. As a result, the aim of our audit was to assess our practice in consenting and institute changes within our department to maintain best medical practice. Methods: An audit of consent form completion was conducted in March 2013. Standards were taken from Good Surgical Practice (2008) and General Medical Council guidelines. Inclusion of consent teaching at a formal consultant delivered orientation programme was then instituted. A re-audit was completed to reassess compliance. Results: Thirty-seven consent forms were analysed. The re-audit demonstrated an improvement in documentation of benefits (91–100%) and additional procedures (0–7.5%). Additional areas for improvement such as offering a copy of the consent form to the patient and confirmation of consent if a delay occurred between consenting and the procedure were identified. Conclusion: The re-audit demonstrated an improvement in the consent process. It also identified new areas of emphasis that were addressed in formal teaching sessions. The audit cycle can be a useful tool in monitoring, assessing and improving clinical practice to ensure the provision of best patient care.

Updated GMC guidance on decision-making and consent: implications for urologists

2020 ◽  
pp. 205141582094553
Author(s):  
Siobhan Duffy ◽  
Catriona Barlow ◽  
Mark Underwood ◽  
Elizabeth Day
Keyword(s):  
Decision Making ◽  
General Medical Council ◽  
Medical Council ◽  
Level Of Evidence ◽  
Consent Forms ◽  
One Stop

We summarise the updated General Medical Council guidance on consent and decision-making. We explore the emphasis on enabling supported decision-making and the implications this has in day to day urological practice. In particular, we address some of the issues encountered in one-stop clinics, on pooled elective lists and with pre-written consent forms. The new guidance will emphasise the importance of sharing information relevant to your patient in light of the Montgomery ruling. Every decision is unique. We must appreciate the importance of the process of decision-making and understand our role as the clinician. Here we suggest some practical considerations to address the updated General Medical Council guidance. Level of evidence: Not applicable.

Changes in surgical consent practices for common otolaryngology procedures: impact of Modernising Medical Careers

2010 ◽  
Vol 124 (8) ◽  
pp. 899-904 ◽  
Author(s):  
P Puwanarajah ◽  
S E McDonald
Keyword(s):  
National Health Service ◽  
Telephone Survey ◽  
Elective Surgery ◽  
General Medical Council ◽  
Medical Council ◽  
Consent Forms ◽  
Department Of Health ◽  
Medical Careers ◽  
Patient Consent ◽  
Selection Of

AbstractObjectives:To assess elective surgery consent practices amongst senior house officers from a selection of UK ENT departments, and to compare results with similar surveys in 2002 and 2005.Methods:A telephone survey of senior house officers in 40 UK ENT departments was conducted to assess departmental consent policies and knowledge of complications of common ENT operations.Results:A total of 77.5 per cent of responding senior house officers were responsible for consenting, reduced from 92.5 per cent in 2002 (p = 0.06). There had been a significant improvement in the use of patient information sheets, from 25 per cent of departments in 2002 to 65 per cent in 2008 (p = 0.0002). There had been no improvement in training or in the use of standard National Health Service consent forms, and the senior house officers' knowledge of specific complications remained poor. Of the senior house officers surveyed, 37.5 per cent were foundation trainees.Conclusions:There has been some improvement in information delivery to patients during the consent process, in accordance with General Medical Council, Department of Health and Modernising Medical Careers guidelines. However, most senior house officers are still required to obtain patient consent without appropriate training.

scholarly journals Risk Factor for Mortality in COVID-19 Patients in Mohammad Hoesin Hospital, Palembang, Indonesia

2021 ◽  
Vol 12 (1) ◽  
pp. 69-76
Author(s):  
Rico Januar Sitorus ◽  
Nyoman Yudi Antara ◽  
Rosyada Elviani ◽  
Zen Ahmad ◽  
Harun Hudari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Length Of Stay ◽  
World Health ◽  
Dominant Factor ◽  
The Novel ◽  
Cross Sectional ◽  
Rapid Spread ◽  
The Mean ◽  
Health Organization

World Health Organization (WHO) has declared the novel corona virus (COVID-19) as a pandemic due to its high transmission and the rapid spread of the COVID-19. Along these lines, there is a need for more research about risk factors that can affect the spread of COVID-19 and its fatality. Therefore, this study aims to analyze risk factors in patients who died from COVID-19 at the Mohammad Hoesin Hospital in Palembang, South Sumatra, Indonesia. This study used a cross-sectional approach. The data were collected from all patients who died with suspected, probable, and confirmed status until September 2020  Data on death due to COVID-19 were collected with suspect, probable, and confirmed status. The results showed that comorbidity became the most dominant factor (62.1%) with (OR Adj) 3.780 (1.000 – 3.168) after controlling for contact history with confirmed cases and sex. There were differences in the mean age and length of stay in patients with confirmed COVID-19 and not. Prevention of death in COVID-19 patients can be done by controlling comorbidities and contact history with positive cases of COVID-19.

scholarly journals X-Bolt unforeseen placement complication: case report

2017 ◽  
Vol 99 (8) ◽  
pp. e227-e229
Author(s):  
AD Clarke ◽  
JBT Herron ◽  
JL McVie
Keyword(s):  
Clinical Trial ◽  
Case Report ◽  
Gold Standard ◽  
The Novel ◽  
Sliding Hip Screw ◽  
Neck Of Femur ◽  
Femur Fractures ◽  
The World ◽  
Hip Screw ◽  
Hip Trauma

With the introduction of the World Hip Trauma Evaluation Four clinical trial, fixation of pertrochanteric neck of femur fractures is becoming a hot topic. In this trial, the novel X-Bolt expanding bolt implant is being compared with the current gold standard of a sliding hip screw. We present a previously undescribed complication when inserting the bolt into the femoral head, where the expandable wings penetrate the femoral neck due to misplacement of the bone crusher or the X-Bolt prosthesis. This unforeseen complication required the introduction of several additional corrective intraoperative steps.

scholarly journals The influence of process and patient factors on the recall of consent information in mentally competent patients undergoing surgery for neck of femur fractures

2012 ◽  
Vol 94 (5) ◽  
pp. 308-312 ◽  
Author(s):  
SK Khan ◽  
K Karuppaiah ◽  
AS Bajwa
Keyword(s):  
Structured Interview ◽  
Visual Aids ◽  
Patient Factors ◽  
Neck Of Femur ◽  
Consent Forms ◽  
Mental Test Score ◽  
Femur Fractures ◽  
Process Factors ◽  
American Society ◽  
A Prospective Study

INTRODUCTION Informed consent is an ethical and legal prerequisite for major surgical procedures. Recent literature has identified ‘poor consent’ as a major cause of litigation in trauma cases. We aimed to investigate the patient and process factors that influence consent information recall in mentally competent patients (abbreviated mental test score [AMTS] ≥6) presenting with neck of femur (NOF) fractures. METHODS A prospective study was conducted at a tertiary unit. Fifty NOF patients (cases) and fifty total hip replacement (THR) patients (controls) were assessed for process factors (adequacy and validity of consent) as well as patient factors (comprehension and retention) using consent forms and structured interview proformas. RESULTS The two groups were matched for ASA (American Society of Anesthesiologists) grade and AMTS. The consent forms were adequate in both groups but scored poorly for validity in the NOF group. Only 26% of NOF patients remembered correctly what surgery they had while only 48% recalled the risks and benefits of the procedure. These results were significantly poorer than in THR patients (p=0.0001). CONCLUSIONS This study confirms that NOF patients are poor at remembering the information conveyed to them at the time of consent when compared with THR patients despite being intellectually and physiologically matched. We suggest using pre-printed consent forms (process factors), information sheets and visual aids (patient factors) to improve retention and recall.

scholarly journals Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery? A retrospective analysis

JRSM Open ◽  
2017 ◽  
Vol 8 (3) ◽  
pp. 205427041667508 ◽  
Author(s):  
Rafik RD Yassa ◽  
Mahdi Y Khalfaoui ◽  
Karunakar Veravalli ◽  
D Alun Evans
Keyword(s):  
Urinary Tract Infection ◽  
Risk Factor ◽  
Urinary Tract ◽  
Hip Fracture ◽  
Tract Infection ◽  
Surgical Site Infection ◽  
Site Infection ◽  
Neck Of Femur ◽  
Femur Fractures ◽  
Tract Infections

Objective The aims of the current study were to determine whether pre-operative urinary tract infections in patients presenting acutely with neck of femur fractures resulted in a delay to surgery and whether such patients were at increased risk of developing post-operative surgical site infections. Design A retrospective review of all patients presenting with a neck of femur fracture, at a single centre over a one-year period. The hospital hip fracture database was used as the main source of data. Setting UK University Teaching Hospital Participants All patients ( n = 460) presenting across a single year study period with a confirmed hip fracture. Outcome measures The presence of pre-operative urinary tract infection, the timing of surgical intervention, the occurrence of post-operative surgical site infection and the pathogens identified. Results A total of 367 patients were operated upon within 24 hours of admission. Urinary infections were the least common cause of delay. A total of 99 patients (21.5%) had pre-operative urinary tract infection. Post-operatively, a total of 57 (12.4%) patients developed a surgical site infection. Among the latter, 31 (54.4%) did not have a pre-operative urinary infection, 23 (40.4%) patients had a pre-operative urinary tract infection, 2 had chronic leg ulcers and one patient had a pre-operative chest infection. Statistically, there was a strong relationship between pre-operative urinary tract infection and the development of post-operative surgical site infection ( p-value: 0.0005). Conclusion The results of our study indicate that pre-operative urinary tract infection has a high prevalence amongst those presenting with neck of femur fractures, and this is a risk factor for the later development of post-operative surgical site infection.

scholarly journals Identify the trends of post-operative haemoglobin level change and risk factors for blood transfusions in surgically managed neck of femur fractures

2016 ◽  
Vol 35 (4) ◽  
pp. 7
Author(s):  
W.Y.M. Abeysekera ◽  
D.H.B. Ubayawansa ◽  
K.D.G.K. Siriwardane ◽  
M. de Almeida ◽  
M.B.N. Dassanayake
Keyword(s):  
Risk Factors ◽  
Haemoglobin Level ◽  
Blood Transfusions ◽  
Neck Of Femur ◽  
Level Change ◽  
Femur Fractures

scholarly journals 50 A Cross-Sectional Study Examining the Association Between MRCS Performance and Surgeons Receiving Fitness to Practice Sanctions

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Ellis ◽  
D Scrimgeour ◽  
J Cleland ◽  
A Lee ◽  
P Brennan
Keyword(s):  
Risk Factors ◽  
Royal College ◽  
Risk Group ◽  
General Medical Council ◽  
Cross Sectional Study ◽  
Early Career ◽  
Disciplinary Action ◽  
Medical Council ◽  
Cross Sectional ◽  
Medical Practitioners

Abstract Aim Fitness to practice (FtP) investigations by the General Medical Council (GMC) can be one of the most stressful experiences in a surgeon’s career. Demographic factors are known to alter the likelihood of GMC investigation. Despite this there are no studies assessing risk factors in surgeons for FtP sanctions. Thus, we used the newly created Intercollegiate Membership of Royal College of Surgeons (MRCS) examination database to identify risk factors for and the prevalence of GMC sanctions in early-career surgeons. Method FtP sanction data contained in the GMC list of registered medical practitioners (LRMP) database was linked at person-level to all UK graduates who had attempted MRCS Part A or Part B between September 2007 and January 2020. Data were anonymised by the Royal College of Surgeons of England prior to analysis. Results f 11,660 candidates who had attempted the MRCS within the study period only 31 (0.3%) candidates had GMC FtP sanctions within the last two years. Of these, 12 had active conditions on their registration, 7 had active undertakings and 14 had warnings. Candidate demographics were similar between cohorts and there were no significant differences between MRCS performance identified. Conclusions In this, the largest study of MRCS candidates to date, the prevalence of active FtP sanctions in early-career surgeons was 0.3%, significantly lower than the prevalence of sanctions across more experienced UK surgeons (0.9%). These data highlight early-career surgeons as a low-risk group for disciplinary action and should reassure patients and medical professionals of the rarity of FtP sanctions.

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