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Use of a Checklist and Video Education to Teach Informed Consent for Epidural Anesthesia
Abstract Number: S-28
Abstract Type: Original Research
Informed consent skills are often lacking and approximately 1% of anesthesia closed claims are due to inadequate informed consent (1). Previous studies report that residents do not fully discuss the benefits, risks, and likelihood of complications (2,3). Even trained anesthesiologists often provide incomplete informed consent (4). In one academic center, 42% of anesthesiologists did not disclose the risk of neurologic injury from neuraxial anesthesia (5). A survey of UK anaesthetists reported that fewer than 25% mentioned several serious risks of neuraxial anesthesia (6).
At our institution, while anesthesiology residents were participating in a standardized patient session to evaluate situational awareness, we were surprised to uncover that they had significant knowledge deficits regarding the risks and complications of epidural analgesia.
Of the 26 residents who participated, the average number of risks mentioned was 4.88 (CA1 – 4.2, CA2 - 5.0, CA3 – 5.5). Patchy block and need for replacement were mentioned by fewer than a third of residents. Neurologic injury was mentioned less than 50%. When the standardized patient asked about complication rates, few residents knew these frequencies. There were no statistically significant differences between junior and senior residents in number of errors made. Clearly, traditional education with lectures may not adequately prepare residents to give appropriate informed consent.
We addressed this educational deficit by developing a standardized video of an informed consent discussion for labor epidurals to show residents. Additionally, because using a checklist can significantly improve patient care (7), we developed a checklist of risks and their associated frequencies to which residents can refer when speaking with patients. A pilot evaluation demonstrated that the checklist dramatically improved the completeness and accuracy of the consent discussion. We hope to present the video as well as the positive results of this educational program on consents and situational awareness at the SOAP meeting.
After observing deficiencies during videotaped informed consents, we developed an educational program including a video and checklist to improve knowledge and skills. Although untested outside of our institution, we believe that similar programs can educate both residents and attending anesthesiologists. We believe that these results also highlight the benefits of a simulated videotaped learning activity in obstetric anesthesiology training.
1: Broaddus BM, et al. Anesth Analg. 2011;112(4):912-5.
2: Huntley JS, et al. J R Soc Med. 1998;91(10):528-30.
3: McClean KL, et al. Acad Med. 2004;79(2):128-33.
4: Lagana Z, et al. Paediatr Anaesth. 2011 Dec 23. Epub ahead of print.
5: Brull R, et al. Reg Anesth Pain Med. 2007;32(1):7-11.
6: Middle JV, et al. Anaesthesia. 2009;64(2):161-4.
7: Neal JM, et al. Reg Anesth Pain Med. 2012;37(1):8-15.