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RISK OF DYING IN PAEDIATRIC ANAESTHESIA: EVALUATION, DISCUSSION AND CONSENT
T. C. Lyne1, H. Donkin Everton2, L. Barkley3, B. J. Blaise4
1Evelina London Children’s Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
2Whittington Hospital, London, UK
3Paediatric Psychology, Evelina London Children’s Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
4Department of Paediatric Anaesthetics, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
Introduction and Aims
Before eliciting a patient’s consent to a procedure, the General Medical Council (GMC) requires that “any risk of serious harm, however unlikely it is to occur” should be discussed.1 According to the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI), all patients should be seen in an anaesthetic pre-assessment clinic, to allow informed consent to be elicited, which includes the discussion of the risks general anaesthesia.2 Unfortunately, patients are not always seen in anaesthetic pre-assessment, making it challenging for anaesthetists to properly disclose the risks of general anaesthesia, including the risk of dying, and gain consent. We conducted an audit at the Evelina London Children’s Hospital to evaluate our consent process, focussing on the discussion of the risk of dying from general anaesthesia in a relatively healthy paediatric population, (ASA I and II).
Methods
The risk of anaesthetic-related paediatric death was estimated in collaboration with NHS England. 21 general paediatric anaesthetists answered a questionnaire on the level of risk information they elected to share with patient’s families. 13 anaesthetists gave their approval for their patient’s parents to be contacted, resulting in 99 families being interviewed. Parental knowledge and understanding of anaesthetic risks, as well as their preferences for the discussion of these risks, were assessed in a questionnaire over the phone.
Results
The risk of paediatric death during anaesthesia was estimated to be 0.37/100,000.
On a scale from 0 to 10, 48% of anaesthetists ranked the chance of them discussing the risk of dying as 2 or lower. While 90% ranked the chance of them saying ‘death’ or ‘dying’ during their anaesthetic assessment as 5 or lower. 74% of anaesthetists felt it was inappropriate to discuss the risk of dying on the morning of the procedure.
79% of families did not recall a discussion of the risk of dying. 72% of families were aware that there was a risk of dying from general anaesthesia. Almost all families said they would like to be told about the risk. Only 37% of families felt that the morning of the procedure was the appropriate time to discuss the risk of dying.
Discussion and Conclusion
Parents expressed a desire to be informed of the anaesthetic risk of dying. Yet currently it remains the anaesthetist’s risk evaluation and their opinion on its importance that determine whether it is discussed. The anaesthetic pre-assessment clinic was deemed by families to be the most appropriate time to discuss the risk of dying. Pre-assessment clinics could provide parents with the framework necessary to facilitate the information assimilation and the shared decision-making required for informed consent to take place, in line with APAGBI1 and GMC2 recommendations.
References:
- General Medical Council. Decision making and consent. 2020. Available from https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/decision-making-and-consent.
- Association of Paediatric Anaesthetists of Great Britain and Ireland. Best Practice Guidance: Preassessment Services for Children undergoing Surgery or Procedures. 2022. Available from https://www.apagbi.org.uk/sites/default/files/2022-05/Best%20Practice_Preassessment%20standards%20in%20Children%20%202022%20-%20Published.pdf
This work has been published in: T.C. Lyne, H. Donkin Everton, L. Barkley and B.J. Blaise, Limitations of the consent process in Paediatric Anaesthesia - Discussion of the risk of dying The DARE audit, Br. J. Anaesth., 2024, in press