K. B. Domino,M.D, M.P.H.; K. L. Posner, Ph.D. et al.
Poor communication between healthcare providers and patients represents a risk to patient safety. When an adverse outcome occurs, the quality of patient-provider communication can be an important factor in determining whether a malpractice claim is filed, as well as the outcome of malpractice lawsuits. Poor communication can also result in patient dissatisfaction and complaints, producing health system costs for complaint resolution. Washington State statute provides specific protections from lawsuits if shared decision-making occurs. The shared decision-making tools must be peer-reviewed, in patient friendly language, and the process must include "teach-back" from patient to provider. The intent of this process is to produce an improved informed consent process that is both standardized by procedure and more informative for patients. It includes elements to ascertain that the patient understands and appreciates the treatment options and their risks and benefits. We propose to implement a shared decision-making process for orthopaedic surgery procedures at UW Medicine. Decision-making will be shared between patients and their orthopaedic surgery and anesthesia providers. We will develop and implement informative, patient-friendly, peer-reviewed, shared decision-making tools for patients undergoing orthopedic surgery with anesthesia. These tools will detail the nature and character of anesthetic and surgical procedures; risks, benefits, and alternatives; follow-up care; and include "teach-back" from patient to provider. We will evaluate the resource requirements (costs) of the process, and compare the quantity, quality and costs of patient complaints and risk management transactions in orthopaedic surgery patients before and after implementation of shared decision-making compared to a control group of surgical patients exposed to the traditional informed consent process without formal shared decision-making. We will also assess patient satisfaction with the shared decision-making process. We will evaluate patient understanding of procedures, benefits, risks and alternatives and post-operative problems before and after implementation of shared decision-making.
Test implementation and evaluation of a surgical and anesthesia shared decision-making process will provide valuable information regarding the costs and effectiveness of shared decision-making tools in improving patient safety and reducing liability. The results will be useful to health systems in making decisions regarding implementation of shared decision-making.