The Risk of Last Minute Consent Communications

It happens in hospitals. It happens in office-based surgery practices and in ambulatory surgery centers. The paperwork is all there: the H&P, the consent form, everything. And then “it” happens: a last minute consent communication.

Sometimes the “it” involves a change in status for the patient. In other circumstances, the patient has made a last minute decision to curtail the scope of the operation. Alternately, a patient may have had “second thoughts” and now agrees with the surgeon to an expanded intervention. And then there are cases in which the surgeon decides to modify the procedure.

When the “it” occurs, does this signal a change in the consent process? Is it merely a matter of crossing out information on the consent form and initialing the change? Should the care provider add an addendum to the consent form and have the patient sign it? Does it matter if “it” occurs after the patient has received some pre-op medication or does not have his or her reading glasses or hearing aides? Is it just an administrative formality or is there more to the changes required by “it”?

A few examples illustrate the challenges of last minute changes during the pre-op process. More than an inconvenience, last minute changes in the surgical plan pose important challenges for an effective consent process and potential liability risk exposure. Effective strategies can help reduce such risk exposure.