Aims: The pre-procedural assessment for elective procedures requires an important shared decision-making process and consent, which is a conversation about the procedure, benefits, risks and alternatives. The guidance from the General Medical Council highlights important steps clinicians should take to ensure patients have a comprehensive understanding of their forthcoming procedure. Handwritten consent forms are often associated with errors of omission, have a lack of standardisation and are often illegible. The safety concerns of face-to-face consultations during the COVID-19 pandemic have increased the need for simplistic, pragmatic and patient-centred solutions to conduct the pre-procedural assessment. We describe our experience in the design and implementation of a novel, digitised pre-procedural assessment pathway.
Methods and results: This was a non-randomised, single-centre study recruiting all patients scheduled for an elective procedure in the department of electrophysiology, who agreed to participate in this survey. All patients were asked questions on their understanding of the procedure, the benefits and risks prior to (n=48) and after (n=134) implementation of a digital pathway. The digital pathway included use of a pre-assessment appointment via video, use of animation-guided consent videos and an electronic consent form (Figure 1A). Patients in the digital group had better understanding of procedural details (54% pre vs 95.5% post), benefits (58% vs 95.5%), risks (50% vs 95.5%) and alternatives (38% vs 86%) (Figure 1B). Two subgroup analyses evaluating the procedural videos (n=65) and the electronic consent (n=18) showed that 88% of patients reported that the video helped their understanding, and 78% preferred the electronic consent to the standard handwritten consent, respectively.
Conclusion: The digital pre-procedural assessment pathway with the aid of procedural videos and electronic consent have increased patient understanding and facilitated their informed decision in our cohort.