It's only natural for patients to be anxious about surgery, but this nervousness can spawn miscommunication, which can snowball into adverse events as minor as poor post-op pain control and as major as wrong-site surgery. While nobody's saying you must calm a patient before surgery, you are legally required to communicate effectively with him. The process is called informed consent, and attempting to document, in compliance with state and federal requirements, everything each patient he needs to know before his procedure can be burdensome.

The solution? Informed consent software. In my experience, automating the process is the best way to improve communication, streamline the process for your staff and increase patient safety - therefore achieving truly informed consent. Here's what you need to know.

A little perspective
While performing dozens of procedures each day is rote for your surgical staff, it's anything but for your patients. Put yourself in a patient's shoes: When he walks into your facility after a restless night of pre-surgical fasting, he's likely tired, apprehensive, thirsty and hungry. The surroundings may be foreign and foreboding and, despite your staff's attempt to instill calm, he remains apprehensive.

The first piece of paper he gets is a consent form that states he has been informed by his surgeon of the surgery to be performed, including the diagnosis, risks and recovery expectations. He may know the procedure I'll be performing is a TURBT (transurethral resection of the bladder), but when he sees "TCC of the bladder/grade Ta," he may have new questions to ask that the administrative assistant can't answer. He may also be overwhelmed by the number of instructions, but may sign the consent form anyhow because it seems things are moving so fast.

This is one of the dangers of taking a manual, non-standardized approach to informed consent: consent that's not truly informed.

Understanding the impact
If you need more proof that relying on generic fill-in-the-blank forms that are populated by the surgeon or your staff isn't sufficient, check out the results of these studies:

• The Archives of Ophthalmology reported in 2004 that inadequate informed consent is the secondary cause in 90 percent of medical malpractice cases.
• A study in The Journal of Bone and Joint Surgery in 2005 found that legal expenses averaged $102,000 less per claim when the informed consent discussion was documented in the standard written consent form and a note was included in the patient's medical record.
• The same study also found that cases lacking the note averaged $374,500 in indemnity payments, while cases with the supplemental note in the patient's chart averaged only $22,600.

Automating the process might not only pre-empt these problems, it could increase patient satisfaction as well. According to a study by Chad Ritenour, MD, an assistant professor of urology at Emory University, patients ranked their satisfaction with computer-based informed consent, compared to traditional informed consent, as 4.5 on a scale of one to five (with one being "very dissatisfied" and five being "very satisfied").

Putting it into practice
I know from experience that improving patient satisfaction and decreasing medical malpractice risks can seem like abstract concepts when you're worried about the here and now. So what does automation mean for your frontline staff?

Realistically, surgeons don't have the time to write out all the necessary aspects of each consent form in language that's easily understood by patients. Using an automated informed consent program lets you take the burden off your physicians by providing real-time access to a library of standardized, reproducible, procedure-specific forms that can be updated with information unique to each patient (see "Informed Consent Software Options"). Remember, not everyone is a teacher; automated informed consent applications provide you with a way to guide surgeons and staff in educating patients about all aspects of their treatment.

The combination means it's easy to document consent and educate patients about conditions, treatment alternatives, benefits and the most common risks of a procedure. You can mail the patient the consent form with his other pre-op information; as a result, the patient ultimately grants his consent with complete comprehension of all possible choices and consequences related to the planned treatment or procedure. If the patient arrives for surgery without a copy of the signed consent form (that you mailed with his other pre-op information), you can quickly print out a duplicate. Either way, that informed choice is documented on both the signed consent form and in the patient's medical record.

Further, automation can help you meet accreditation standards. CMS requires that consent forms detail risks, alternatives and the specific surgical tasks that will be performed by practitioners other than the primary surgeron. Additionally, one of JCAHO's National Patient Safety Goals for 2007 specifically encourages patients' active involvement in their own care. When patients understand all possible risks and potential complications - including the slight chance that equipment might fail or that in some cases a procedure may lead to unfavorable outcomes - they are empowered.

Justifying the cost
While the price tag on automated consent may seem large at first glance - up to several thousand dollars annually, depending on case volumes or number of physicians, plus any up front installation and software costs - you have to consider that if you avoid even one malpractice suit, automated informed consent has paid for itself.