Organisational risks matter and should be discussed during consent: survey of 980 neurosurgery patients from the UK.

Abstract

Introduction: During consent, surgeons discuss surgical and anaesthetic risks with patients. We investigated whether patients also wish to be informed about hospital organisational risks.

Methods: We used a cross-sectional survey. A questionnaire with three real-life scenarios of hospital organisational problems likely to increase the risk of surgery was given to 1,003 patients in neurosurgical departments of three United Kingdom (UK) teaching hospitals. The scenarios were: (1) computer failure in the operating room; (2) lack of surgical equipment; and (3) bed shortage or lack of operating capacity causing postponement of surgery. We quantified how strongly participants wish to be informed about organisational risks, whether this information alters a patient's decision to have surgery, and the desire of patients to discuss these risks further.

Results: In total, 980 of 1,003 (97.7%) questionnaires were returned and 84.3%-88.5% of patients wished to be informed about hospital organisational risks - more women than men (odds ratio [OR] 1.6-1.8, p < 0.05). Knowledge of the hospital organisational risks would influence 69.2%-70.4% of participants' decisions to have surgery; 74.9%-78.3% of participants wished to discuss the organisational risks with surgeons and 50.0%-60.8% with hospital managers before surgery. Some 69.4% of patients were concerned about organisational risks vs 77.1% who were concerned about surgical risks.

Conclusions: Most neurosurgery patients consider hospital organisational risks to be material. To comply with the Montgomery ruling in UK medicolegal case law, neurosurgeons and hospital managers should discuss with patients the organisational risks in addition to the surgical and anaesthetic risks during consent.