Consent for emergency treatment: Emergency department patient recall and understanding
Correspondence / American Journal of Emergency Medicine 37 (2019) 1362–1393 1387
Table 1
Patient demographic and stress tests information.
Patient demographics
Frequency (n = 57) Percent
Gender
Male |
20 |
35% |
Female |
37 |
65% |
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Coskun U, Jildiz A, Esen OB, Baskurt M, Cakar MA, Kilikesmez KO, et al. Relationships between carotid intima-media thickness and coronary angiographic findings: a pro-
Ethnicity |
|||
White |
24 |
42.1% |
|
Black |
21 |
36.8% |
|
Hispanic |
10 |
17.5% |
|
American Indian |
1 |
1.8% |
|
Asian |
1 |
1.8% |
|
Age |
Consent for emergency treatment: Emergency |
||
Mean Age |
53 |
department patient recall and understanding |
|
Min Age |
33 |
Max Age Stress test |
79 |
|||
Frequency (n = 57) |
Percent |
|||
Exercise stress ECHO |
33 |
57.9% |
||
Pharmacologic stress ECHO |
22 |
38.6% |
||
Pharmacologic nuclear stress |
2 |
3.5% |
Table 2
2 x 2 table for positive CIMT on either side.
Stress Pos |
Stress Neg |
||
CIMT Pos |
4 |
26 |
30 |
CIMT Neg |
1 |
26 |
27 |
5 |
52 |
57 |
Table 3
2 x 2 table for positive composite average CIMT.
Stress Pos |
Stress Neg |
||
CIMT Pos |
4 |
16 |
20 |
CIMT Neg |
1 |
36 |
37 |
5 |
52 |
57 |
References
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Informed consent is a crucial component of patient autonomy and shared decision-making. Previous studies have shown that comprehen- sion of a variety of types of informed consent by patients is poor [1-3]. This study was undertaken to identify patient recall and understanding of the emergency department (ED) Consent for Treatment document.
In this prospective survey study design, eligible participants in- cluded ED patients age 18 and older, who were able to communicate, not in distress, and consented to participate. After signing informed con- sent document per ED registration protocol, a convenience sample of patients meeting the inclusion criteria were invited to participate.
A total of 293 patients consented to participate (95% participation rate). The mean age was 52 and the majority of participants were female (58%) and White (62%). The majority of participants stated that they had signed a consent document (N = 272; 93%). A minority of patients read the entire document (7%) or read part of the document (11%). Most patients did not read the document (36%) or received only a verbal ex- planation (45%) (Table 1). Many patients did not recall anything about what they signed (N = 107; 39%). The most frequently recalled ele- ments of consent included consent for treatment (N = 144; 52%), infor- mation regarding finances and billing (N = 36; 13%), and privacy rights (N = 12; 4%) (Table 2).
Reading the document prior to signing was associated with African American ethnicity (p = 0.01). Age, gender, mode of arrival, and triage level were not associated with reading the document (Table 3). Respon- dents who indicated they didn’t know what they had consented to were significantly older (median 56 years) than respondents who remem- bered something from the consent form (median 47; p = 0.01). A
Table 1
Did you read the document prior to signing?
Yes, I read the entire document 20 (7%)
artery intima and media thickness as a risk factor for myocardial infarction and stroke in older patients. N Engl J Med 1999;340:14-22.
a More than 1 response possible. Percentages are calculated based on n = 276.
1388 Correspondence / American Journal of Emergency Medicine 37 (2019) 1362–1393
Table 3
Associations with reading the document prior to signing.
References
verbally explained
Age (years,
median [IQR]
278
44 [34-55]
53 [34-60]
55 [40-68]
49 [32-64]
0.13
Male
117
9 (7.7%)
12 (10.3%)
50 (42.7%)
46 (39%)
0.25
Female
161
11 (6.8%)
19 (11.8%)
51 (31.7%)
80 (50%)
African
95
9 (9.5%)
14 (14.7%)
22 (23.2%)
50 (53%)
0.01
American White
170
11 (6.5%)
15 (8.8%)
74 (43.5%)
70 (41%)
Walk-in
201
18 (9.0%)
24 (11.9%)
73 (36.3%)
86 (43%)
0.22
Ambulance
Triage level
74
2 (2.7%)
7 (9.5%)
26 (35.1%)
39 (53%)
2
74
4 (5.4%)
8 (10.8%)
29 (39.2%)
33 (45%)
0.16
3
175
16 (9.1%)
18 (10.3%)
66 (37.7%)
75 (43%)
4
27
0 (0%)
5 (18.5%)
5 (18.5%)
17 (63%)
higher percentage of walk-in respondents (56%) recalled consenting to treatment compared to ambulance arrivals (41.1%; p = 0.02). Respon- dents with higher triage levels more frequently recalled consenting to treatment (p = 0.02).
When asked for comments about the consent for treatment process, the majority had no problems with the process or no specific comments (237 (81%)).
Informed consent is an important ethical and legal component of medical care. In this study, we demonstrated that the majority of ED pa- tients in this study recalled signing a consent document, but most were not aware of elements of the consent document they had signed. De- spite this lack of awareness, the majority of participants indicated they were satisfied with the current process. These data speak favorably of patient trust in ED providers.
health literacy is an important component of communication with patients. Poor health literacy is common among ED patients [4]. The In- stitute of Medicine (IOM) reports that over 90 million people, nearly half the adult population lack proper health literacy skills to understand their health [5]. Improving understanding of one’s health is crucial to maintaining patient’s autonomy and decision-making capacity. Some studies have reported a variety of approaches to improving patient health literacy [6-8].
In conclusion, the majority of ED patients in this study recalled signing a consent document. Most were not aware of elements of the Consent for Treatment document they had signed. Walk in patients were more likely to recall the document than patients who arrived by ambulance. Patients high lower triage acuity recalled consenting to treatment compared to higher acuity.
Catherine A. Marco Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America
Corresponding author.
E-mail address: [email protected].
Ashley LaFountain Ashwatha Thenappan
Daniel E. Ross
Wright State University Boonshoft School of Medicine, Dayton, OH, United
States of America
12 January 2019
https://doi.org/10.1016/j.ajem.2019.01.019
completing the informed consent process. Clin Trials 2014 Feb;11(1):70-6.
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N
1. Read all
2. Read
3. Did
4. Did not
p-Value
[1] Mexas F, Efron A, Luiz RR, Cailleaux-Cezar M, Chaisson RE, Conde MB. Understanding
parts
not read
read but
and retention of trial-related information among participants in a clinical trial after
Sanchini V, Reni M, Calori G, Riva E, Reichlin M. Informed consent as an ethical re- quirement in clinical trials: an old, but still unresolved issue. An observational study to evaluate patient’s informed consent comprehension. J Med Ethics 2014 Apr;40 (4):269-75.
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of health literacy with preventable emergency department visits: a cross-sectional study. Acad Emerg Med 2017 Sep;24(9):1042-50.
Institute of Medicine. In: Nielsen-Bohlman L, Panzer A, Kindig DA, editors. Health lit- eracy: a prescription to end confusion. Washington, D.C.: National Academy Press; 2004
- Tait AR, Voepel-Lewis T, Chetcuti SJ, Brennan-Martinez C, Levine R. Enhancing patient understanding of medical procedures: evaluation of an interactive multimedia pro- gram with in-line exercises. Int J Med Inform 2014 May;83(5):376-84.
- Perrenoud B, Velonaki VS, Bodenmann P, Ramelet AS. The effectiveness of health lit- eracy interventions on the informed consent process of Health care users: a system- atic review protocol. JBI Database System Rev Implement Rep 2015 Oct;13(10): 82-94.
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Comparison of Quick Track(TM) and Melker(TM) for emergent invasive airway management in Simulated Obese Model
To the Editor,
emergent cricothyrotomy is the final step in managing difficult air- ways [1,2]. The Quick Trach II(TM) (QT; VBM Medizintechnik GmbH, Sulz am Neckar, Germany) was developed for direct placement in the tra- chea using the catheter-over-needle technique. In contrast, the Melker Set(TM) (Melker; Cook Group Incorporated, Bloomington, IN) uses a guide-wire for placing the cannula with the Seldinger method. It re- mains controversial which of direct placement or the Seldinger method is optimal for invasive airway management.
While invasive airway management is known to be difficult in obese patients, no comparison of efficacy of QT and Melker devices have been performed in this patient population. Against this backdrop, the present study aimed to compare the performance of QT and Melker devices in terms of efficacy of cricothyrotomy on an obese manikin.
Ethical approval was deemed unnecessary by the institutional re- view board of Osaka Medical College, and written consent was obtained from each participant. Participants were 15 doctors specialized in criti- cal care such as emergency medicine or anesthesiology who were re- cruited from a difficult airway training course at Osaka Medical College. Participants had 7.5 +- 4.9 years of Clinical training, and had used the QT 4.8 +- 3.9 times and the Melker 6.6 +- 3.2 times for cricothyrotomy in clinical or simulated situations.
The SimMan(R) 3G (Laerdal, Sentrum, Stavenger, Norway) mani- kin was used in this study. The obese model was constructed by attaching 1 cm of simulated subdermal tissue (CVC training pad, Kyotokagaku, Japan) to the Cricothyroid membrane (Fig. 1a, b). In the Melker trial, participants used the Melker set, which consisted of a needle, a syringe, a guide-wire, a scalpel, a dilator, a 5-mm can- nula with an Inflatable cuff, and a syringe for blocking the cuff. In the QT trial, participants used the QT set, which consisted of a syringe, a conical-shaped needle, a plastic 4-mm cannula with an inflatable cuff, and a stopper [3]. Participants were given 30 min to practice these techniques, with the instructor available for advice. A trial started when the participant picked up the QT or Melker and ended