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Is informed consent better on a computer?
There's a new trend in outpatient surgery toward computer-based informed consent. But does this method offer any advantages, legal or otherwise? Yes, according to sources interviewed by Same-Day Surgery.
"One of the biggest advantages of computer-based informed consent is the immediate viewing/verification of the consent form in different areas of the hospital," says Michael S. Fladland, MSN/HCA, RN, manager of the Portland Outpatient Procedures and Surgeries (POPS) unit at Portland VA Medical Center.
At his facility, the ORs are on separate floors. Patients having outpatient procedures will be checked in on the POPS floor, then transferred to an OR suite in a different area of the hospital. "The OR nurses are able to verify the consent is complete electronically prior to the patient entering the room," Fladland says.
The VA hospitals in Portland and other locations use the iMedConsent program from Dialog Medical in Atlanta for all procedures. The program is designed for doctors and patients to review together. There are some versions written for patients with a sixth-grade reading level.
"We also use the computer-based discharge education form [developed inhouse and added to iMedConsent] where the patient/family member will sign that they received the document and then save electronically," Fladland says. "If a patient encounters difficulty post-discharge and calls the advice line, the advice nurse has access to the exact discharge form to refer the patient or family member to for assistance." Staff go over the patient's education in the form and then have the patient sign using the electronic signature pad.
This discharge education does offer a legal advantage, he says, as patients often don't remember the discharge form or discard it. "We've had multiple occasions where patients/families stated they did not receive discharge education, and the computer-based model offers the nurse physical documentation that education was provided and signed for by the patient or family member," Fladland says.
At University of Chicago Medical Center, the Emmi program from Emmi Solutions in Chicago is required for patients sent by primary care physicians for a colonoscopy.
Patients view a video that is 20 minutes long and "explains in layman's terms what a colonoscopy is, what a patient can expect on the day of the procedure, and also highlights some of the risks and benefits of the procedure," says Leslie Wallene Yang, MD, assistant professor of medicine in the Department of Medicine, Section of Gastroenterology, Hepatology & Nutrition. "We have so far received positive feedback from patients that they felt less anxious about the procedure and had a better understanding as to why their physician ordered the procedure after watching the video. We are currently studying whether watching this video improves patient attendance and bowel prep." If you are adding computerized informed consent, plan ahead to have the right number of computers to ensure a smooth continuous process "or you set yourself up for delays," Fladland says. "Often times the physicians want to complete a consent prior for pre-op at the same time the nurses are discharging, so there needs to be adequate computer availability."
Downtime "creates chaos"
Another potential problem occurs when computers aren't functional. "Computer downtime is always a problem and creates chaos, but we always have our paper forms to refer back to when necessary." Fladland says.
Consider what obstacles might exist for patients using such a system, Yang advises. "For instance, we were concerned that some patients would not have computer access at home, so we set up computer kiosks in our clinic for EMMI viewing," she says. Primary care physicians also have the option of sending patients to the gastroenterology clinic for further consultation if there is any concern that they patient cannot view or understand the program for any reason, Yang says. "Ultimately, our goal is to enhance patient education of the procedure, so we try to make the process as convenient as possible for our patients and referring physicians."
Another caveat is that the computer cannot take the place of the physician educating the patient, Yang says. "This program should be used in addition to the standard physician informed consent and not as a substitute," she says. "While it does go over risks and benefits of the procedure, it is still important that the physician review them with the patient prior to the procedure."
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