Description of orthopaedic operations is inaccurate in half of consent forms

EDITOR,—It is recommended that written consent meeting professional guidelines should be obtained before any operative procedure.1 2 3 Often, this written consent is used as a final preoperative check on the site, side, or nature of the proposed procedure, and thus its accuracy is important.

We reviewed the accuracy of completion of consent forms in the orthopaedic department of a teaching hospital by examining a random sample of 180 such forms and their associated operative procedures. All inaccuracies, abbreviations, or faults in the operative description were noted. Legibility was not analysed, although the standard varied considerably. The faults were divided into three categories according to their seriousness, as follows.

Technical errors, where the doctor wrote the operative description in an abbreviated form but this posed little risk of the wrong operation being performed. Such errors included the use of single letters or abbreviations—for example, R or Rt (for “right”) or ORIF (for “open reduction with internal fixation”)—and # to indicate fracture.

Important errors, where the risk of the wrong operation being performed was increased but, owing to the form's obvious deficiencies, its reliability would have been questioned before the operation—for example, the operative procedure was incompletely described or the side or digit was omitted.

Serious errors, where important inaccuracy was found (for example, the wrong operation, side, or digit was written down).

Half of the consent forms were accurately and comprehensively filled in. The remainder contained one or more faults. When more than one category of error occurred the most important one determined the categorisation. The commonest fault—the use of single letters or abbreviations to denote the side of the proposed procedure—was found in 50 of the 180 forms. Abbreviations and the # sign were found in 36. The bone or side involved was not mentioned in 18. Two forms had serious errors: one patient had given consent for a procedure on his uninjured side and one for a different procedure from that which he had been told would be done. These discrepancies remained undetected during the several preoperative checks. No errors in treatment or care occurred despite these serious faults.

An error rate of 50% is unacceptable, and the potential consequences of this level of inaccuracy are important. We would warn other surgeons of the dangers of using the consent form as a preoperative and peroperative guide to the proposed procedure and strongly recommend increased supervision of junior doctors when they gain patients' consent.