Informed consent for patient transfers to a Veterans Affairs medical center.
OBJECTIVE
To evaluate whether informed consent was obtained prior to transfers of patients from a community hospital to a Veterans Affairs medical center.


METHODS
Cross-sectional study.


METHODS
A Department of Veterans Affairs medical center.


METHODS
Eighty-six consecutive interhospital-transferred patients. Nearly all were white men, with a median age of 62.5 years. Fifty percent had three or more active medical problems and 17% had been transferred from intensive care units.


RESULTS
The authors defined informed consent as a discussion of benefits, risks, and alternatives to transfer. Following transfer, patients and physicians were interviewed using standardized parallel questionnaires. Physician-patient communication regarding the benefits and risks of transfer was infrequent. Informed consent was reported for none of the transfers by patient interview, compared with 11% of the transfers assessed by physician interview. Risks of transfer were discussed infrequently according to both physicians (17%) and patients (13%). Physicians perceived a risk to the patient in 21% of patient transfers, and in 36% of transfers defined by objective criteria as high-risk. Physicians recalled discussing benefits of transfer more frequently than did patients (80% vs. 42%,t test, p less than 0.001). Physicians also recalled discussing alternatives to transfer more frequently than did patients (61% vs. 18%, t test p less than 0.001).


CONCLUSIONS
Verbal informed consent is obtained infrequently prior to interhospital transfer of patients. Risks of transfer are seldom perceived and discussed with patients.
Jablonski
D F
DF
Division of General Internal Medicine, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin 53295.
Mosley
G M
GM
Byrd
J C
JC
Schwallie
D
D
Nattinger
A B
AB
D000368:Aged; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D030881:Disclosure; D005260:Female; D006764:Hospitals, Community; D006787:Hospitals, Veterans; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000331:legislation & jurisprudence; D010819:Physician's Role; D012306:Risk; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014481:United States