Monday, March 21, 2016

Doctors Improve Informed Consent Forms, Process

Thanks to efforts by a group of Texas Medical Association (TMA) physicians, Texas is improving patient care before the doctor even touches the patient. The Texas Medical Disclosure Panel (TMDP) improved how a physician or health care provider obtains a patient’s permission before giving care, known as informed consent. Some doctors see the change as an opportunity to improve patient safety and patient-centered care.

“If patients feel that they are fully informed and actively involved from the beginning and that they've made a choice with the physician, they tend to leave feeling more satisfied, no matter the outcome,” Meredith A. Reyes, MD, co-chair of TMA’s Subcommittee on Transfusion and Transplantation told TMA’s Texas Medicine magazine.

Dr. Reyes and her committee saw a need to improve the informed consent system. The doctors noticed the state consent forms for blood transfusion were outdated, so they pushed TMDP for changes that the state ultimately adopted in January, after two years of dialogue. The old state forms largely addressed potential blood transfusion complications that were prevalent 20 years ago but not as common today. When it comes to blood transfusion, “the first things people think about are HIV and hepatitis. And now those things are not zero risk, but they are no longer the highest risk,” said Dr. Reyes, because health care providers now test and screen heavily for HIV. Instead, more common complications include bacterial infections, allergic reactions, and fluid overload. So the revised form addresses the more common risks.

Having patients sign the routine form creates a chance to get patients involved in their care. Dr. Reyes sees a need.

“I talk to patients on a daily basis who don’t feel like they know what’s happening with their treatment. Whether it’s transfusion or a procedure, they don’t feel like doctors are talking to them in a way they can understand,” she said.

So this process aims to ensure patients do understand, so they can make an informed decision whether to undergo a treatment or procedure. And physicians are better protected from legal claims for failing to adequately disclose potential complications. “The form is really just to document that the conversation occurred,” said TMDP Chair Noah B. Appel, MD. “I often meet the patient shortly before the procedure, especially if it’s an emergency. It’s important to me for patients to feel comfortable, and I use that conversation to say, ‘Here's what we know; here are the risks; here are the potential benefits.’ And they can talk with me and ask me questions.”

The TMDP, a panel of physicians and attorneys working under the auspices of the Texas Department of State Health Services, is improving informed consent forms in other ways too. The group, which meets several times a year to review medical procedures and risks, asked The University of Texas at Austin’s Department of Communication Studies to translate the sometimes complex forms to an average adult reading level.

And Parkland Health and Hospital System in Dallas recently automated its informed consent form process to free up physicians’ time to focus on their patients. The hospital automated the entire informed consent process by fully integrating it into its electronic health record system.

“The automation of the informed consent process means reduced waste and time, and it gives that time back to the doctors to spend with the patient,” said Parkland Chief of Infection Prevention Pranavi Sreeramoju, MD. “It's just good patient care.” The physician, a member of TMA’s Council on Health Care Quality, also sees the informed consent process as an opportunity for improving care quality and patient satisfaction.

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