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A4587 - Use of Bundled Informed Consent in United States Academic Medical Intensive Care Units: A National Survey
Author Block: A. M. Anandaiah1, N. S. Ward2; 1Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States, 2Rhode Island Hosp, Providence, RI, United States.
Rationale: Obtaining timely informed consent for each procedure required by a critically ill patient represents a challenge for intensive care unit (ICU) providers. Previous studies have suggested that the use of a single bundled consent tool for multiple procedures that is reviewed at the time of admission with the patient or surrogate may lead to improved rates of documented informed consent and family satisfaction without sacrificing patient/surrogate comprehension. We sought to determine the current prevalence of bundled consent use in U.S. academic ICUs and to gather related information about training and attitudes regarding different methods of procedural consent. Methods: A survey was distributed to the membership of the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD). Surveys were distributed three times by email and once in person at an annual meeting. Only one response per hospital was accepted. Results: We received 102 responses out of a total of 144 active pulmonary and critical care fellowship programs, resulting in an overall response rate of 71%. 31% of program directors reported using bundled informed consent in their primary academic ICU, with an average range of 5-9 procedures included. Residents were the ICU team members most often obtaining bundled consent (64%), largely without any specific training on its use (85%). Among those who used bundled consent (n=28), 85% reported either positive or neutral attitude towards it; however, only 27% reported confidence that the bundled consent approach resulted in valid informed consent for each procedure. When asked to rate specific aspects of each approach, respondents gave bundled consent higher ratings for efficiency and easing burden on patients and families but lower ratings for legal validity and ethical appropriateness. Conclusions: Bundled informed consent is now used in almost one third of U.S. academic ICUs. Advantages of bundled consent may include efficiency and decreased burden on patients and families, but it is regarded by both users and nonusers as less valid and ethical as compared to an individual procedural consent approach.