# Enhancing Documentation Standards of Complications in Informed Consent for Neck of Femur Fracture Surgery

## TL;DR

This study aimed to improve how complications are documented in informed consent forms for femur neck fracture surgeries by implementing teaching and visual aids.

## Contribution

The study introduces targeted interventions to enhance documentation of surgical complications in consent forms for NOF fractures.

## Key findings

- Initial documentation rates for complications were below 50% in most categories.
- Post-intervention improvements were observed in documenting pain, avascular necrosis, and mortality for NOF fixation.
- Documentation for THR improved in areas like bleeding, dislocation, and infections.

## Abstract

Background

Neck of femur (NOF) fractures are a major cause of morbidity in the United Kingdom. Operative management is the standard of care, and informed consent is essential to ensure patients understand potential benefits and complications arising during the surgical management of NOF fractures. This study aimed to assess and enhance the quality of Consent Form 1 documentation of complications of NOF fracture surgery as per the British Orthopaedic Association (BOA) and to assess improvements following focused interventions.

Methodology

A closed-loop audit was conducted in the Trauma and Orthopaedic Department, Heartlands Hospital, Birmingham, from February to October 2024. In the first cycle, we analyzed the Consent Form 1 retrospectively for the documentation of complications. Interventions for improvement were performed, including teaching sessions and posters on consent documentation. The second cycle assessed post-intervention practice. The study encompassed patients with capacity who underwent fixation, hemiarthroplasty, or total hip replacement (THR). Documentation was considered complete if it included all common, less common, and rare complications.

Results

The initial documentation rates were modest, with fewer than 50% of forms recording pain, catheterization, avascular necrosis, hip stiffness, limb length discrepancy, and mortality. Post-intervention improvements were observed, including pain, avascular necrosis, and death for NOF fixation, alongside better values of infection, altered wound healing, pulmonary embolism, and bone damage for hemiarthroplasty. For THR, improvements were seen in the documentation of bleeding, dislocation, blood clots, prosthetic wear, infections, altered wound healing, bone damage, and death.

Conclusions

Targeted teaching and visual reminders improved documentation, but there are persistent gaps. Further strategies are required to standardize consent practices and ensure complete patient information in line with BOA guidance.