Tom Burton. SET4 General Surgical Trainee currently working at Waikato Hospital
Does Direct Access Surgery Allow Truly Informed Consent?
Aim The New Zealand public health system is at capacity therefore innovative ways to expediate patient care are necessary. One way could be direct access surgery, with referral from general practitioners to surgery without pre-operative clinic assessment. A concern with this model is consent for care. Informed consent is a cornerstone to good medical care, and is a process rather than simply signing a form. We wanted to explore whether a direct access surgery impacts patients’ perception of informed consent.
Methods Between 2012-2017, Bay of Plenty general practitioners (GP) were invited to refer fit patients (ASA 1or2 ,BMI<35 and<60 years old) with symptomatic cholelithiasis, but no cholecystitis directly to a surgical list. The patients GP provided patients with written information, a video on the procedure and administered a preoperative health questionnaire. Patients presented on the day of surgery, were seen, consented and underwent day stay cholecystectomy. Post-operative follow-up was GP lead. A post-operative questionnaire was undertaken to gauge the patients views on the overall process.
Results 41 patients were referred via the Direct Access Surgery pathway. 37 patients were deemed appropriate with 35 proceeding directly to surgery. Waiting time from referral to operation was reduced from 120 to 59.3 days. 30 patients (86%) had day-stay procedures. Three patients (8%) re-presented with ongoing right upper quadrant pain within one year requiring further investigation. A written voluntary post-operative questionnaire was sent to all patients who underwent DAS with an 80% response rate. Eighty five percent of patients (24/28) agreed or strongly agreed that they felt fully informed regarding the operation and were happy with the consent process.
Conclusions Direct Access Surgery is an effective way to streamline healthy patients’ access to operative intervention and appears to allow enough information for patients to give informed consent. Direct access surgery could be expanded for other surgical procedures.