Exploring patient participation in reducing health-care-related safety risks

Exploring patient participation in reducing health-care-related safety risks
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The ERS developed a study in 2007 that aimed to describe the national state of affairs
concerning the application of informed consent at operational level. Public and private
entities were requested to send their informed consent forms as part of the study,
and 120 valid answers were received (41). The results showed that the application of
informed consent was heterogeneous among the different health care units and, in some
circumstances, even within the same unit. Moreover, some health care units did not even
have policies related to informed consent (41).
In a study of informed consent quality carried out in 2009 in the surgical unit of the
Porto Hospital Centre, Santo Antonio Hospital, 63.5% of respondent patients underwent
elective surgery. Of these, 73.7% had a low level of education, 51.1% were men and 62%
were retired. The authors reported that 86.1% of patients undergoing surgery received
information about surgery-related issues; this information was provided by the surgeon
in 62.8% of cases. Just over 50% received the information minutes, hours or days before
the surgery, while 49.2% received it weeks or months before. Just over 30% did not
receive information about other treatment options but 81.4% considered that they had
received sufficient information. Relationships with the surgeon and participation in SDM
independently influenced each patient’s satisfaction with the informed consent process (79).
Patient engagement and surgical safety
Elective surgery gives the patient the opportunity to improve the quality of care received
by understanding treatment options and working with HCWs to make the surgery as
safe as possible (80). Surgery consists mostly of elective procedures and most of the
available data reflect this. The majority of patients in the Porto study mentioned above
did not know the meaning of informed consent, even though all had given their informed
consent before surgical procedures or important diagnostic tests. Patient gender, literacy
and previous hospitalizations seemed to exert an influence on the results (41).
According to the 2006 Eurobarometer survey of medical errors, 18% of Europeans
and 16% of Portuguese citizens had experienced a serious medical error in a hospital.
Most Portuguese citizens (66%) thought it was unlikely that a hospital patient could
have any influence on avoiding a medical error and only 23% believed that a hospital
patient could actually help in their prevention (81). Increased awareness is nevertheless
perceptible in the 2010 Eurobarometer survey of patient safety and quality of health
care, in which 50% of Europeans and 64% of Portuguese believed that being harmed by
hospital health care was “likely”. When asked to state their views of the likelihood of
occurrence of specific adverse events, 67% felt that HAIs were likely to occur and 58%
saw a potential for surgical errors (82).
The 2010 Eurobarometer survey revealed that 17% of European health consumers who
reported that they or a member of their family had undergone surgery in the previous
three years stated that written consent was never obtained. In Portugal, 24% stated that
written consent was never, and 16% only sometimes, obtained (82).
The WHO Second Global Patient Safety Challenge, “Safe Surgery Saves Lives”,
recognizes the importance of the patient undergoing surgery as a member of the team
(9). During the treatment process, the surgical team “contributes information about