title: Breakdown of the consent process at a quaternary medical center: our full disclosure.
abstract: Circumstances may arise in the intensive care unit (ICU) when the physician is unable to obtain informed consent. We undertook this study to determine the variations in the consent process. An anonymous survey was distributed to all critical care nurses (RN), resident physicians (RES),  advanced practitioners (AP), and attending physicians (ATT). Participants were asked to describe the risks of nine common ICU procedures (central venous line, peripherally inserted central catheter, bronchoscopy, tube thoracostomy, tracheostomy, vena cava filter, angioembolization, image-guided  drainage, and percutaneous endoscopic gastrostomy tube). Participants were also asked which member of the healthcare team should obtain consent. All groups were compared with ATT responses and RN responses were compared with the remaining groups. The response rate was 134 of 610 participants  (22%) with 51 per cent RN (n = 68), 17 per cent RES (n = 23), 7 per cent AP (n = 9), and 25 per cent ATT (n = 34). Compared with ATT, RN assessment of important risks varied significantly for eight of nine procedures. RES responses varied in three procedures. A minority believed that nurses  should obtain consent. However, many physicians (34% ATT and 27% RES) denied having informed consent discussions with 50 per cent or more of their patients. This study has exposed a wide variation in consent practices. Future efforts to standardize consent processes are needed to protect patients  and physicians.
authors.affiliation: F.H. Sammy Ross, Jr. Trauma Center, Carolinas Medical Center, Charlotte, North Carolina, USA.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Fairfax
authors.forename: A Britton
authors.initials: AB
authors.lastname: Christmas
authors.forename: H James
authors.initials: HJ
authors.lastname: Norton
authors.forename: David G
authors.initials: DG
authors.lastname: Jacobs
mesh_terms: D016009:Chi-Square Distribution; D030881:Disclosure; D006302:Health Services Research; D006801:Humans; D007258:Informed Consent / Q000592:standards* / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D009657:North Carolina; D009726:Nurses; D010348:Patient Care Team / Q000592:standards*; D010820:Physicians; D017064:Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires