Informed Consent Practices for Hip Fracture Surgeries at a Tertiary Care Hospital in Wad Madani, Sudan

TL;DR

This study examines informed consent practices for hip fracture surgeries in Sudan, finding significant gaps in documenting surgical risks and patient details.

Contribution

The study identifies specific shortcomings in consent documentation by junior medical staff in a Sudanese hospital.

Findings

Resident trainees and medical officers obtained most consents, but key risks like neurovascular injury were often omitted.

Only 68% of forms included the diagnosis or reason for surgery, and none specified blood transfusion needs or patient identification.

Orthopedic-specific risks were frequently overlooked, likely due to insufficient training among junior staff.

Abstract

Introduction: An essential component of medical ethics and practice is informed consent. The General Medical Council (GMC) and the Royal College of Surgeons of England (RCS) provide guidelines for obtaining valid consent. Failing to obtain sufficient or valid consent can have legal consequences.

Materials and methods: Over a period of two and a half months, from March 12 to May 28, 2022, a retrospective cross-sectional study was conducted to evaluate consenting practices for neck of femur fracture surgeries. A total of 88 patient consent forms were reviewed. The standard consent forms utilized in this study were those endorsed by the British Orthopaedics Association (BOA) and were based on the guidelines provided by the RCS and the GMC.

Results: Resident surgical trainees and medical officers obtained the majority of the consents, 31 (35.22%) and 49 (55.68%), respectively. The most frequently reported risks included infection, blood clots (deep vein thrombosis and pulmonary embolism), bleeding, and wound complications. Neurovascular injury was not mentioned in 75 (85.33%) consent forms. Additionally, hip stiffness, prosthetic dislocation, death, and leg length discrepancy were not discussed with any of the patients. Additionally, we observed that the diagnosis or reason for surgery was mentioned in only 60 (68.18%) consent forms. Furthermore, none of the forms specified the intended benefits, the necessity for a blood transfusion, or the patient identification details.

Conclusion: Our study revealed inadequate documentation of surgical risks in patient consent forms for neck of femur fracture surgeries, with orthopaedic-specific risks often overlooked. This issue likely results from insufficient orthopaedic training among the medical officers and junior resident trainees responsible for obtaining consent. We recommend induction teaching sessions to improve their understanding of standard consenting practices and associated risks, along with implementing patient identification stickers.