Informed consent for invasive procedures in the emergency department

Published:January 28, 2020DOI:



      Informed consent for procedures in the emergency department (ED) challenges practitioners to navigate complex ethical and medical ambiguities. A patient's altered mental status or emergent medical problem does not negate the importance of his or her participation in the decision-making process but, rather, necessitates a nuanced assessment of the situation to determine the appropriate level of participation. Given the complexities involved with informed consent for procedures in the ED, it is important to understand the experience of key stakeholders involved.


      For this review, we searched Medline, the Cochrane database, and for studies involving informed consent in the ED. Inclusion and exclusion criteria were designed to select for studies that included issues related to informed consent as primary outcomes. The following data was extracted from included studies: Title, authors, date of publication, study type, participant type (i.e. adult patient, pediatric patient, parent of pediatric patient, patient's family, or healthcare provider), number of participants, and primary outcomes measured.


      Fifteen articles were included for final review. Commonly addressed themes included medical education (7 of 15 studies), surrogate decision-making (5 of 15 studies), and patient understanding (4 of 15 studies). The least common theme addressed in the literature was community notification (1 of 15 studies).


      Studies of informed consent for procedures in the ED span many aspects of informed consent. The aim of the present narrative review is to summarize the work that has been done on informed consent for procedures in the ED.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. 2015 National hospital ambulatory medical care survey.
        National Center for Health Statistics
        (Available from)
      2. Dictionary of cancer terms.
        (Internet]. Available from)
        • Sulmasy L.S.
        • Bledsoe T.A.
        • for the ACP Ethics, Professionalism and Human Rights Committee
        American College of Physicians ethics manual: seventh edition.
        Ann Intern Med. 2019; 170: S1
        • Feinstein M.M.
        • Pannunzio A.E.
        • Lobell S.
        • Kodish E.
        Informed consent in pediatric anesthesia: a narrative review.
        Anesth Analg. 2018; 127: 1398-1405
        • Tierney S.
        • Perlas A.
        Informed consent for regional anesthesia.
        Curr Opin Anaesthesiol. 2018; 31: 614-621
        • Sturgess J.
        • Clapp J.T.
        • Fleisher L.A.
        Shared decision-making in peri-operative medicine: a narrative review.
        Anaesthesia. 2019; 74: 13-19
        • Moher D.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Ann Intern Med. 2009; 151: 264
        • Denny C.J.
        • Kollek D.
        Practicing procedures on the recently dead.
        J Emerg Med. 1999; 17: 949-952
        • McNamara R.M.
        • Monti S.
        • Kelly J.
        Requesting consent for an invasive procedure in newly deceased adults.
        JAMA. 1995; 273: 310-312
        • Olsen J.
        • Spilger S.
        • Windisch T.
        Feasibility of obtaining family consent for teaching cricothyrotomy on the newly dead in the emergency department.
        Ann Emerg Med. 1995; 25: 660-665
        • Spencer S.P.
        • Stoner M.J.
        • Kelleher K.
        • Cohen D.M.
        Using a multimedia presentation to enhance informed consent in a pediatric emergency department.
        Pediatr Emerg Care. 2015; 31: 572-576
        • Yamamoto L.G.
        • Young L.L.
        • Roberts J.L.
        Informed consent and parental choice of anesthesia and sedation for the repair of small lacerations in children.
        Am J Emerg Med. 1997; 15: 285-289
        • Lin K.-Y.
        A parental educational intervention to facilitate informed consent for pediatric procedural sedation in the emergency department.
        5. 2013
        • Levin S.M.
        H.R.4449 — 101st Congress (1989–1990): Patient Self-determination Act of 1990.
        (Internet. [cited 2019 Apr 24];Available from)
        • American Academy of Pediatrics Committee on Bioethics
        Informed consent, parental permission, and assent in pediatric practice.
        Pediatrics. 1995; 95: 314-317
        • Fourre M.
        The performance of procedures on the recently deceased.
        Acad Emerg Med. 2002; 9: 5
        • Morhaim D.K.
        • Heller M.B.
        The practice of teaching endotracheal intubation on recently deceased patients.
        J Emerg Med. 1991; 9: 515-518
        • O’Malley G.F.
        • Giraldo P.
        • Deitch K.
        • et al.
        A novel emergency department-based community notification method for clinical research without consent.
        Acad Emerg Med. 2017; 24: 721-731
        • Bellolio M.F.
        • E Silva L.O.J.
        • Alencastro Puls H.
        • Hargraves I.G.
        • Cabrera D.
        The research to practice continuum: development of an evidence-based visual aid to improve informed consent for procedural sedation.
        J Clin Transl Sci. 2017; 1: 316-319
        • Revell S.
        • Searle J.
        • Thompson S.
        The information needs of patients receiving procedural sedation in a hospital emergency department.
        Int Emerg Nurs. 2017; 33: 20-25
        • Easton R.B.
        • Graber M.A.
        • Monnahan J.
        • Hughes J.
        Defining the scope of implied consent in the emergency department.
        Am J Bioeth. 2007; 7: 35-38
        • Santen S.A.
        • Hemphill R.R.
        • McDonald M.F.
        • Jo C.O.
        Patients’ willingness to allow residents to learn to practice medical procedures.
        Acad Med. 2004; 79: 144-147
        • Graber M.A.
        Patient opinions and attitudes toward medical student procedures in the emergency department.
        Acad Emerg Med. 2003; 10: 1329-1333
        • Fox E.E.
        • Bulger E.M.
        • Dickerson A.S.
        • et al.
        Waiver of consent in noninterventional, observational emergency research: the PROMMTT experience.
        J Trauma Acute Care Surg. 2013; 75: S3-S8
        • Kodish E.
        • Eder M.
        • Noll R.B.
        • et al.
        Communication of randomization in childhood leukemia trials.
        JAMA. 2004; 291: 470-475
        • Yap T.Y.
        • Yamokoski A.
        • Noll R.
        • et al.
        A physician-directed intervention: teaching and measuring better informed consent.
        Acad Med J Assoc Am Med Coll. 2009; 84: 1036-1042