# Improving the Completeness of Surgical Consent Documentation Through a Closed-Loop Quality Improvement Audit at a Secondary Care Teaching Hospital

## TL;DR

A hospital in Sudan improved surgical consent documentation by implementing a quality improvement audit with staff education and revised forms.

## Contribution

A closed-loop audit approach with targeted interventions significantly improved consent documentation completeness in a resource-limited setting.

## Key findings

- Baseline documentation completeness was very low for key domains like hospital number and surgical indication.
- Post-intervention, most components achieved 100% compliance, with surgical and anaesthetic risk explanations reaching 93.2% and 97.7%.
- Some areas like possible additional procedures and patient incapacity documentation still showed partial compliance.

## Abstract

Background

Incomplete surgical consent documentation undermines informed decision-making, patient safety, and medico-legal protection. Despite clear ethical and professional standards, deficiencies in consent documentation remain common, particularly in resource-limited settings.

Objective

To assess the completeness of surgical consent documentation, implement targeted quality improvement interventions, and evaluate their impact through a closed-loop clinical audit.

Methods

A closed-loop quality improvement audit was conducted at Almanagil Teaching Hospital, Sudan. Two audit cycles were performed, each reviewing 44 consecutive surgical consent forms. The first cycle (July-August 2025) established baseline compliance with predefined consent documentation standards. A structured intervention, including staff education, feedback, and introduction of a revised consent form, was implemented over two months. The second cycle (October-December 2025) reassessed documentation completeness using the same criteria. Data were analysed descriptively and reported as frequencies and percentages.

Results

At baseline, documentation completeness was low in several key domains, including hospital/file number (1.8%), surgical indication (5.4%), explanation of procedure (16.1%), and anaesthetic and surgical risk explanation (1.8% each). Following the intervention, substantial improvements were observed across nearly all components. Documentation of consent, anaesthesia type, physician and witness details, and patient satisfaction confirmation reached 100% compliance. Explanation of anaesthetic and surgical risks increased to 97.7% and 93.2%, respectively. Documentation of possible additional procedures and patient incapacity details improved to 47.7% and 50.0%, although these remained below full compliance.

Conclusion

This audit demonstrates that structured, audit-driven quality improvement interventions can markedly enhance the completeness of surgical consent documentation. Regular auditing and sustained reinforcement are recommended to maintain improvements and address remaining gaps.