Elements of care require documented patient consent and patient care staff need to review required consent prior to performing care. Paper consent forms are completed by handwriting required elements such as “procedure” and “risks,” and then the provider and consenting party provide signatures. If handwriting is illegible, the paper consent form is misplaced or the consent is not readable due to poor scanning technique, procedures can be delayed and present a patient safety risk. Electronic consent workflows can improve the quality of this process and reduce potential patient safety issues. Employing principles of a quality improvement framework, our institution initiated an enterprise-wide implementation of an electronic consent workflow. Our initial experience has shown improvements in consent completion.
After the identification of areas with higher consent volume, a new feature in our electronic health record (EHR) was rolled out one department at a time. Staff had the ability to access specific department phrases and terms to assist with creation of the consent. Ease of use, familiarity with the HER, and targeted staff training supported user adoption. To support review and consent by the consenting party, dedicated patient/family tablet devices were deployed to each area as part of implementation. Consenting parties also had the option to review and sign via patient portal.
Process mapping of current and future consent workflow was completed to assist with understanding the associated steps and responsibilities. Additionally, to understand current state practice, a manual audit of institution-based consent-related incident reports was completed. To assist with evaluation of this implementation, review of pre- and post-implementation consents by department were completed. Post-implementation results found electronic consents 100% of the time and all required elements of the consent were legible. Our results support the potential of this workflow to decrease risks to patent safety and increase efficiency by removing the delay of finding a paper consent, finding a consent that had been scanned but is not easily read, or finding a consent that is illegible. Tracking adoption of this process by department has also been set up and will inform leadership of any need to further investigate implementation issues or need for training support.
Children's Hospital of Philadelphia