Universal Consent Practice in Academic Intensive Care Units (ICUs)

Abstract

The purpose of this study was to determine national practice for obtaining consent in academic adult intensive care units (ICUs) for routine bedside procedures and to define universal consent rates by patient demographics within our own institution’s ICUs.

Methods: A 10-question survey was sent to the program directors for all U.S. surgical and pulmonary critical care directors regarding consent practices. Further, the adoption of a universal consent protocol in an academic county hospital was studied.

Results: Cross-sectional study: Thirty-seven percent of program directors completed the survey. Consent rates varied from 35% to 97% by procedure, with only 14% using a universal consent document. Providers in Medical ICUs obtained consent more often than in Surgical ICUs for both central line and pulmonary artery catheter placement (82.8% and 93.1% vs. 52.6% and 52.6%, respectively). Prospective cohort study: At our institution, 90% of 363 patients or their proxies signed universal consent for procedures, 4.4% consent with exemptions, while 5.2% refused. Insured patients were 2.7 times more likely to sign full universal consent for bedside ICU procedures than uninsured patients.

Conclusion: There was a national variation in ICU consent practices with an interest in a wider usage of universal consent protocols. The latter was adopted differentially based on patient demographics. Universal consent was widely accepted at our institution.

Keywords

intensive care unit invasive procedures informed consent surgical intensive care unit medical intensive care unit

Get full access to this article

View all access options for this article.

References

Luce JM Is the concept of informed consent applicable to clinical research involving critically ill patients? Critical Care Med. 2003;31(3):s153-160.

Ciroldi M. , Cariou A. , Adrie C. , et al. Ability of family members to predict patients’ consent to critical care research. Intensive Care Med. 2007;33(5):807-813.

Manthous CA , DeGirolamo A. , Haddad C. , Amoateng-Adjepong Y. Informed consent for medical procedures: local and national practices. Chest. 2003;124(5):1978-1984.

Schweickert W. , Hall J. Informed consent in the intensive care unit: ensuring understanding in a complex environment. Curr Opin Crit Care. 2005;11(6):624-628.

Davis N. , Pohlman A. , Gehlbach B. , Kress JP , et al. Improving the process of informed consent in the critically ill. JAMA. 2003; 289(15):1963-1968.

Degirolamo A. , Mallareddy M. , Verrabjadraiah D. , et al. Informed consent for invasive procedures in a community hospital medical intensive care unit . Connecticut Medicine. 2004;68(4):223-229.

Clark PA Intensive care patients’ evaluations of the informed consent process . Dimensions in Critical Care Nursing. 2007 ;26(5):207-226.

American Medical Association. The Graduate Medical Education Directory 2001-2002. Chicago, IL: Fred Donini-Lenhoff Medical Education Products; 2000- 2001.

Chenaud C. , Merlani P. , Ricou B. , et al. Informed consent for research in the ICU obtained before ICU admission. Intensive Care Med. 2006;32(3):439-444.

10.

Fan E. , Shahid S. , Kondreddi VP , et al. Informed consent in the critically ill: a two-step approach incorporating delirium screening. Crit Care Med. 2008;36(1):94-99.