TITLE: (UN)INFORMED CONSENT FOR TRANSFUSION: A SURVEY OF CURRENT PRACTICE IN US HOSPITALS

AUTHORS: Joyce A. Wahr, MD, Alan Tait, PhD, Edward B. Goldman, JD, Kevin K. Tremper, MD, PhD
AFFILIATION: University of Michigan, Ann Arbor, MI.

INTRODUCTION: The Joint Commission on Accreditation of Hospitals asks that all hospitals obtain informed consent for blood transfusion, but does not specify how it is to be done. Some states require detailed forms (CA, Paul Gann Act), but most do not. The purpose of this study was, therefore, to determine how, or if, hospitals in the US obtain transfusion consent (TC).
METHODS: All hospitals listed in the American Hospital Association Guide to the Health Care Field were sent a questionnaire regarding their current practice for obtaining TC. Hospitals were asked to submit any forms used. Zip codes of responders were obtained from the return envelopes. All forms submitted were assigned a numerical rating depending on the presence and quality of risk description, alternatives to transfusion, and consequences of transfusion, as well as the writing quality (written at the level of lay public versus lawyers or physicians) and appropriateness. Data were analyzed using Statview software (SAS, Cary, NC).
RESULTS: A total of 5,125 surveys were sent. Over 2,000 surveys have been received and 1000 have been analyzed to date. Only 284 hospitals did not provide a form for analysis (28%). Government hospitals comprised 4% of the responders, academic centers 6%, community hosiptals with residency programs 16%, and community hospitals without resisency programs 73%. Of the respondents, only 1.3% stated that they do not obtain TC, with 80% of the hospitals using a form specific to transfusion. The remainder of the hospitals include TC with consent for treatment (admission, 1%) or surgery (11%). Physician documentation of verbal consent is used in 7% of the hospitals responding. Nearly 6% of the forms submitted asked for consent with no information provided about risks, alternatives, or consequences. Consent forms from the larger hospitals had significantly higher quality scores and were more likely to be written at the level of the lay public. Some degree of risk information was provided in 70% of the forms analyzed, but fewer provided information about alternatives (30%) and about consequences (22%). Only 4% of the forms provided information in another language or via translator.
DISCUSSION: A large majority of responding hospitals use a specific instrument to obtain consent for transfusion. The amount and quality of information provided for the patient to make an "informed" decision, however, varies considerably between institutions. Furthermore, a number of hospitals asked to be absolved of any and all adverse events associated with a trans- fusion, presumably including those resulting from staff errors.