Anesthesia consent for icu patients

[Chloroform4Life]

How many of yall go out of your way to try to reach family members to discuss risks and benefits of anesthesia for patients who can't communicate?

I routinely look up family members phone number and call them just to give heads up about potential complications, especially death in these patients. Most of the anesthesiologists I work with never attempt to contact family and never even see these patients until they arrive in the OR, where they go and sign the prefilled "consent of anesthesia" in the chart that the ICU nurse have the family member sign. They just look up the electronic medical record before the case.

Since I'm the outlier in my practice, I'm wondering how you guys are doing it? Am I doing extra work needlessly here?

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[fakin' the funk]

IMO, it's ethically, medically, and legally the correct thing to do to obtain consent for your services, with exception for implied consent/emergency type situations.

I call.

 

[Ignatius J]

Oh man, I'm the definition of a Cowboy but I am going to speak to a family member if at all possible. I can't imagine not keeping them in the loop and explaining stuff to them.

From a guy whose had relatives in the ICU, it's very important to me.

 

[Mman]

we always get in person consent if relatives are at bedside or phone consent if they are reachable by phone. Once in a while can't get a hold of POA but they did phone call the surgical consent and we just imply consent for the anesthetic.

 

[caligas]

we always get in person consent if relatives are at bedside or phone consent if they are reachable by phone. Once in a while can't get a hold of POA but they did phone call the surgical consent and we just imply consent for the anesthetic.

What about for the 6th washout? Call every time?

 

[Chloroform4Life]

we always get in person consent if relatives are at bedside or phone consent if they are reachable by phone. Once in a while can't get a hold of POA but they did phone call the surgical consent and we just imply consent for the anesthetic.

This implied consent for anesthetic..... how valid is it? If it is valid, then why even try to call or get consent in person? I think this implied consent is what the other anesthesiologists in my group rely on.

I mean I agree with you and I do exactly what you do. I don't go around cancelling cases if I can't get hold of a family member either.

 

[Mman]

What about for the 6th washout? Call every time?

depends on the conversation for the previous cases. If it is somebody that we know will be coming back frequently, we document that we discussed anesthetic care for current and upcoming cases.

 

[WholeLottaGame7]

depends on the conversation for the previous cases. If it is somebody that we know will be coming back frequently, we document that we discussed anesthetic care for current and upcoming cases.

Same. Things like burns or WVAC changes or sedation for heme/onc procedures, we get serial consents (usually renewed after 6 months).

I also call for consent for ICU cases.

 

[wickedskillz]

The state of Texas now requires a separate anesthesia consent, performed by an anesthesiology provider. We do this once and make sure the family understands the risks, then use the same consent throughout the hospital stay (generally speaking, we're still doing the same procedure, which is a GA). If the patient's condition has worsened and is being taken for a particularly risky procedure, I would probably talk to family again and make sure they know the risk is higher now.

 

[bigdan]

We call for each and every anesthesia consent if the patient is "unconsentable".

My residency's trauma hospital had a 30 day anesthesia consent - I didn't realize how lucky we were to have that. We would get a consent at the time of the first procedure, and most of us would get consent for central and arterial line, GA, and blood transfusion. Covered us for a month. That's a win. We tried to get it on all cardiac and thoracic patients, as well as any polytrauma and ortho long bone fractures. Miss that now.

 

[Doctor4Life1769]

Implied consent is sometimes questionable when consent by the surgical service (resident) is attained over the phone via a MINOR... Happened to me once during residency. Surgical resident didn't realize the person on the phone was a minor, and I tried to get consent for anesthesia but could not get a hold of anyone until someone finally answered and it was a 10 year old who said he gave consent. I told him he needed to get in touch with his parent in order for the father to be consentable. Wife had no clue. It was hilarious and sad.

 

[WholeLottaGame7]

Implied consent is sometimes questionable when consent by the surgical service (resident) is attained over the phone via a MINOR... Happened to me once during residency. Surgical resident didn't realize the person on the phone was a minor, and I tried to get consent for anesthesia but could not get a hold of anyone until someone finally answered and it was a 10 year old who said he gave consent. I told him he needed to get in touch with his parent in order for the father to be consentable. Wife had no clue. It was hilarious and sad.

Had a surgical resident "get consent" from a demented elderly patient who just scribbled all over the page. It was abundantly clear from talking to the patient that he was incapable of giving consent, and looking through his record, one of his family members had given consent for his other procedures. I called the family member and got consent and then just handed the phone to the surgical resident.

The new issue at our hospital is kids in DSS custody. It used to be that the DSS official would give consent for procedures, but now it has to be the biological parents, even if the kid is living with foster parents under DSS custody. Unless the parents have specifically waived their rights to give consent. It strains the limits of common sense to bypass the foster parents and the DSS workers (who actually care enough about the kid to bring them to their medical appointments) in order to sometimes spend hours or days trying to get in touch with the cracked-out mom who hasn't seen her kid in months.