Planning ahead: the case for early surgical consent
Imagine arriving to the hospital at 5 a.m. for surgery and being ushered into the preoperative area, a large room where patients are separated only by thin curtains. Waves of healthcare providers come to evaluate you to ensure you are prepared for surgery. This pit crew of specialists includes preoperative nurses, operating room nurses, as well as anesthesiology and surgery team members who must greet, evaluate and document, for you to proceed with surgery. There is an intense level of noise pollution from conversations, telemetry alarms, pagers, phones, measurement of vital signs and more. All of this is occurring in a limited time span to get the patient to the OR on time and keep the day on schedule.
In our recent study, we found that patients who signed surgical consent on the morning of surgery in the pre-operative area were three times more likely to experience operating room delays than those who signed earlier. For hospitals, each minute in the OR can cost more than $35. But the consequences extend beyond efficiency. They raise ethical concerns and conflict with patient-centered care.
The preoperative area is not the optimal environment to obtain consent. It is a chaotic setting where patients may struggle to absorb information and ask questions before signing consent. By the time patients arrive in the preoperative area, the decision to undergo surgery has already been made in clinic. Ideally, reviewing the contents in the written surgical consent form and signature for consent should have been completed then. The patient may feel pressured in the preoperative area, being too far along the surgical pathway to ask questions that the consent form may raise or to reconsider surgery. Delaying consent completion and signature to the preoperative area is solely for the convenience of the health system or surgeon. 
On top of that, we found that patients with limited English proficiency were almost four times more likely to face surgical delays, revealing another inequity in perioperative care. Each delay, whether caused by consent timing or communication barriers, ripples across the day’s schedule, adding stress and cost for patients, clinicians and hospitals alike.
The fix is simple: for elective cases, complete surgical consent prior to the day of the surgery. However, it is important to acknowledge certain logistical concerns: in some states, surgeons cannot legally delegate the consent process to other staff; the consent form may not be readily available in clinic; or institutions may mandate consent form expiration dates. Consent is a continuous process or ongoing conversation that is confirmed in the preoperative area. When we give patients the time and space needed to make informed decisions, we create safer, more patient-centered, and more efficient surgical care.
By Dr. Victoria Yin, general surgery resident
