CONSENTING FOR ENDOSCOPIC PROCEDURES - HOW CAN WE OPTIMISE THE PROCESS?

Aims The British Society of Gastroenterology (BSG) consent guidelines advise that good consenting practice is an important part of the Global Rating Scale (GRS) assessment of UK endoscopic units. The high volume of outpatients undergoing elective endoscopic procedures can lead to insufficient consent documentation. We aimed to review our consent process and identify factors where it could be optimised.

Methods We performed a one-week prospective study at a London-based district general hospital during May 2019. Data was collected for 70 consecutive patients that underwent elective endoscopy: Gastroscopy (n=20), Colonoscopy (n=20), Gastroscopy + Colonoscopy (n=20) and Flexible sigmoidoscopy (n=10).In our Trust, consent forms for gastroscopy and colonoscopy are pre-printed whilst those for a combined gastroscopy + colonoscopy procedure and flexible sigmoidoscopy are manually completed. We compared the completion of consent forms for each procedure and the source of information provided to the patients prior to it (outpatient discussion, telephone call or written information).

Results Of the 70 patients undergoing endoscopy, 66 (94.3%) felt they received adequate information prior to the procedure either from a written source or telephone call. Sedation risk was documented in 85% receiving conscious sedation.

Tab. 1 Consent process - consultant vs. nurse endoscopist

	Consultant (n=49)	Nurse endoscopist (n=21)	*p value
Legibility(n, %)	33 (67.3)	21 (100)	p = 0.01
Missed pathology (n, %)	5 (10.2)	21 (100)	p < 0.05

Conclusions Despite inadequate consenting for missed pathology and risks of sedation in 1 in 5 patients, almost all patients felt they received adequate information for their procedures. Manually filled consent forms were not completed to the standards of pre-filled consent forms. Nurse endoscopists were significantly more likely to write legibly and consent for missed pathology than consultant gastroenterologists. We advise that pre-filled consent forms be introduced for all commonly performed endoscopic procedures and that written consent for ‘missed pathology’ is included in all cases.