EGS SO09 - Documentation Of Mortality While Consenting For Major Emergency Operation In General Surgery : Are We Informing Patients Or Just Impressing NELA? A Three-Cycle Clinical Audit

Abstract Background Approximately 30,000 to 50,000 emergency laparotomies are performed annually in the United Kingdom (UK), with an in-hospital mortality rate of 9.2%. The UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report from 2011 recommends that the risk of mortality should be explicitly discussed with patients and clearly documented on consent forms and in medical records. The purpose of our audit was to assess the frequency of documenting the risk of mortality in consent forms and to evaluate the reporting of corresponding discussions in the medical records of patients undergoing major emergency general surgical operations. Method Patients were identified from our National Emergency Laparotomy Audit (NELA) database, and data was collected retrospectively from our online medical records. We included procedures from NELA performed on patients aged 16 and older who had the capacity to give consent. The first audit cycle took place from April to June 2021, the second from March to May 2022, and the third from March to May 2023. The results of the first cycle revealed gaps in documentation, leading to the implementation of periodic reminders for surgeons during meetings and the use of posters to reinforce best practices. Results The 1st cycle included 40 cases, with 93% documented mortality in NELA, 40% in consent forms, and 35% documented discussion about mortality in medical notes. The 2nd cycle reviewed 38 cases, showing 92% documented mortality in NELA, 71% in the consent forms, and 42% of documented discussion about mortality in the medical notes. The 3rd cycle assessed 32 cases, with 90% documented mortality in NELA, 92% in consent forms, and 51% in the medical notes. The improvement in documentation of the risk of death in the consent forms was statistically significant across all three cycles (p < 0.0001). Conclusion The three audit cycles demonstrated that implementing periodic reminders and posters for surgeons significantly improved the documentation of mortality risk. Documentation rates in consent forms increased from 40% in the first cycle to 92% by the third cycle, and in medical notes from 35% to 51%. These interventions effectively enhanced compliance with best practices. However, continuous effort is essential to maintain this improved practice. Regular monitoring, ongoing education, and reinforcement strategies should be employed to ensure that the documentation standards remain high and continue to improve patient care and safety.