Case for Templates
The Argument for Customizable Templates and Electronic Surgical Consent Forms and Guidelines in Podiatry
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The Foot and Ankle Research Consortium, www.PodiatryPrep.com, the Institute of Medical Business Advisors www.MedicalBusinessAdvisors.com, the www.MedicalExecutivePost.com and The Institute for Clinical Systems Improvement http://www.icsi.org/ among others, are strong proponents for the value of templates and evidence-based clinical guidelines, and cites the following objections that make their implementation and acceptance more difficult. These issues generally apply to health information technology assessments, like eMRs, and pHRs, as well:
Guidelines are a legal hazard: There is a fear that following a guideline that turns out to be wrong increases the risk of litigation. Good templates guidelines, however, are evidence-based and not opinion-based drivers of care. Furthermore, once a review of the podiatric surgical literature takes place and is synthesized into a preliminary guideline, multi-specialty physician focus groups review the guidelines prior to finalization. The strength of evidence supporting each conclusion is usually stated, highlighting areas of remaining scientific uncertainty. “Evidence hierarchies” are often used as aids to grading recommendations, with meta-analysis, systematic reviews, and randomized controlled trials being at or near the top of the hierarchy in strength, with narrative reviews, case reports, and medical opinion pieces being considered the weakest forms of evidence. This provides additional checks and balances to core guideline and template development.
Guidelines are cookbook medicine: Guidelines are just that – guidelines. Each patient should be provided treatment according to his/her individual needs. Templates and evidence-based clinical guidelines are based on extensive reviews of the literature and are applicable to the vast majority of cases for a particular clinical condition but not necessarily all cases. In the case of practice pattern evaluation or profiling, comparisons of such patterns to podiatric medical guidelines can help identify overall systematic variations from the norm rather than variations due to particular patients with special needs.
Guidelines do not work: When used as the sole basis for practice improvement, this statement contains some truth. However, when incorporated into a systematic continuous quality improvement approach, they have been shown to improve practice patterns and reduce variation.
Podiatrists will not use guidelines: Once podiatric physicians know that the guidelines are based on a sound review of the medical literature, practitioner buy-in greatly increases. In addition, clinicians need to realize that clinical guidelines are only one part of the total treatment picture since a team approach to patient care is becoming the norm.
Guidelines need validation through actual outcomes data: This is correct when based on a continuous quality improvement approach, but is incorrect if outcomes are based on individual events. Local implementation of guidelines can be compared to outcomes data one or two years after implementation. Depending on the actual level of podiatric practice pattern improvement, minor and major alterations can be made to the guidelines to reflect local needs and DPM acumen.
Self-Customizable and Doctor Flexible
National guidelines for podiatry in some cases may need adaptation to local patient needs and concerns. For example, a podiatry practice in a major metropolitan area where specialty care is readily available differs in major ways from a rural practice which is based more on primary podiatry care. Practices where many patients are poor or on public assistance also differs from practices in affluent areas. When used as basic guides to appropriate practice, however, clinical guidelines can significantly decrease practice variation.
Assessment
With the recent emphasis on evidence-based medicine and on decreasing the time lag between evidence publication and its effect on actual patient care, a number of agencies have added templates, clinical guideline and technology assessment development to their task lists.
Conclusion
Such agencies include specialty societies such as the American College of Cardiology (ACC), private companies and non-profit organizations, governmental bodies such as the Agency for Health Care Research and Quality (AHRQ), and MCOs that review the scientific evidence for the purpose of determining coverage policy.
Thus, it is now time for e Podiatry Consent Forms.
Your patients deserve nothing less!
ORDER: https://epodiatryconsentforms.com/order-form/
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From KRAMES
In this new whitepaper from Krames, learn which improvements to the informed consent process will equip patients and healthcare professionals to improve overall patient care.
Link: Krames.Informed.Consent
e Podiatry Consent Forms 
“Medicine operates like a private club of self-styled deities where the entrance requirement is an MD.”
Peter Pronovost MD in a Wall Street Journal article on physician resistance to checklists and collaboration.
Rex
Rex
March 31, 2010 at 1:48 am
More Benefits of ePodiatryConsentForms™ on CD-ROM
• Unrestricted and unlimited access to your CD
• Pay once – keep forever – model
• Not a subscription service
• Always accessible anywhere/anytime from your PC
• Access to “Live” support available for help on any procedure
• Consent forms maintained by licensee continuously updated
• Available in MS-Word format for custom use
• May be converted to Adobe PDF files for fixed use.
The Editors
Editors
April 19, 2010 at 3:44 am
On Medical Checklists and Surgical Templates
In his “Checklist Manifesto” bestseller, Atul Gawande MD points out that much of what ails us in health care is the lack of good checklists.
Not just the lists of course, but the fact that much of health care is now rote stuff that we already know how to do. What we need to do is accept that and stop treating the work like it’s a craft-brewed, once-in-a-lifetime invention. We need to start treating it like a complex set of tasks that needs to be done well, in order, every time and preferably by technicians specially trained to repeat the list.
Source: Jonathan Bush
[CEO athenahealth]
Ann Miller RN, MHA
May 14, 2010 at 10:41 am
Getting Consent
Informed consent is a simple concept: patients must be made fully aware of the course of treatment. Risks and benefits must be spelled out and patients must give their OK before anything.
Simple, in theory, but in practice, informed consent has become more of a paperwork exercise. It’s not just that doctor compliance is haphazard, but also that the quality of the dialogue between clinician and patient often leaves a lot to be desired.
Dr. Ben
Dr. Ben
July 22, 2010 at 11:59 am
Compliance Problems Solved
e-Podiatry Consent Forms will help you comply with CMS Conditions of Participation. This unique automated informed consent tool is designed to help you easily and effectively create and execute a well-designed consent form containing most all practical elements detailed in the CMS State Operations Manual.
In addition, e-Podiatry Consent Forms will help DPMs and facilities comply with Joint Commission accreditation requirements for patient safety, informed consent processes and documentation, and patient education.
More compliance info: https://epodiatryconsentforms.com/why-us/
Editors
e-Podiatry Consent Forms
e-Podiatry Consent Forms
October 9, 2010 at 7:25 pm
Wrong Site Surgery Continues
Patients undergoing surgery still risk falling victim to stunning medical mistakes – ranging from an operation on the wrong surgical site – to undergoing surgery intended for another patient – to the lack of real informed consent; a new study finds.
To try to curb the rate of surgical errors, the Joint Commission in 2004 introduced a universal protocol and checklists for all hospitals, ambulatory care facilities and office-based surgical facilities to follow.
http://archsurg.ama-assn.org/cgi/content/short/145/10/978
However, even though these steps have largely been adopted, errors continue to happen, the researchers reported.
So, http://www.ePodiatryConsentForms.com is a great idea!
Stewart
Stewart
October 20, 2010 at 1:27 pm
My Philosophy
The principles underlying this process are that it should be facilitative rather than prescriptive, i.e. that doctors have choice in the details of the information contained in the consent process. It should be patient specific, i.e. that the information is tailored to each individual patient’s requirements. The info is also procedure-specific, i.e.tailored to the individual doctor’s needs and methodology.
Dr. David Edward Marcinko; MBA
[CEO and Publisher-in-Chief]
Dr. David Marcinko
March 3, 2011 at 7:55 pm
Why the big deal?
Medical ethicists have long known that, if trust is indeed the cornerstone of the successful doctor-patient relationship, that subjecting a person to medical or surgical treatment without discussing all aspects thereof wherever possible, i.e. fully informed consent, constitutes a betrayal of that trust.
Common opinion asserts that good informed consent creates better mental preparation for surgery, decreased anxiety, shorter hospital stays, earlier recognition of complications by patients before they become serious, and a generally higher success rate and satisfaction rate for the surgery.
70% of the detail of discussion about surgical detail and risk held in doctors’ rooms is forgotten by patients by the time the consultation is over. Patients are ordinarily asked to consent to surgical procedures ‘on the spot’ without access to the detailed documentation of the risks of those procedures that they can consider in their own time and own comfortable environment.
A person knowing all the information about his or her procedure acts as another measure of control to avoid outright human error, such as the wrong operation, or operating on the wrong side.
Almost every case of litigation following surgery will address the adequacy of the consent process.
The right to full knowledge about medical or surgical interventions is entrenched as a human right, even legally enforceable by inclusion in the constitutions of some countries.
No longer is a successful surgical outcome adequate protection against litigation, particularly where the consent is deemed to have contained inadequate information.
In an environment where litigation is on the increase, and expectations, demands and knowledge by the public have heightened, adequate and fully informed consent is one of the few protections doctors can apply both to their own benefit and to that of their patients.
Martin Young MD
Martin Young MD
March 14, 2011 at 11:58 am
Atul Gawande: [The Power of Surgical Checklists] [Video]
In the second part of his conversation with H&HN senior editor Matthew Weinstock, surgeon, writer and public health researcher Atul Gawande, M.D., discusses how checklists can build safer hospitals, and explores his partnership with the South Carolina Hospital Association to install checklists in every state hospital.
http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=8960004717
“When properly implemented, surgical checklists can save thousands of lives.”
Video running time: 6:54
Editors
July 27, 2011 at 5:44 pm
Automating Informed Consent to Reduce Risk
[Healthcare Informatics – November 17, 2011]
James Gottesman, MD describes his personal experience with a medical malpractice claim and how the patient’s acknowledgement of the risks itemized on the detailed, procedure-specific consent form was the evidence that compelled the jury to find for Dr. Gottesman.
http://www.dialogmedical.com/2011/11/17/automating-informed-consent-to-reduce-risk/
This review article also discusses a study of consent documents from 157 hospitals which found only 26 percent of the forms to be complete. Use of electronic solutions is cited as, “the way to document the discussion between the physician and patient.”
Editors
Editors
March 10, 2012 at 4:53 pm
Even Hositals Using Templates and Checklists
Now, a group of top health-care providers and hospitalists is offering a checklist of ten strategies for tackling the broader issue of delivering improved healthcare at reduced cost.
http://blogs.wsj.com/health/2012/06/06/a-different-kind-of-checklist-for-hospitals/?mod=WSJBlog
This, of course, is the purpose of e Podiatry Consent Forms.
Ann Miller RN MHA
[Executive Director]
Editors
June 7, 2012 at 10:13 am
Q: Invaluable suggestions and I learned a lot from the specifics. Does anyone know if I would be able to access a template VA 21-0779 example to complete?
A: Our consent forms are for surgery; not nursing homes.
Editors
marthpavia1607gmail
August 3, 2016 at 4:50 pm
Interoperability
Informed Consent for the real-world physician.
http://www.medicaleconomics.com/business/interoperability-informed-consent-real-world-physician?rememberme=1&elq_mid=4752&elq_cid=108378&GUID=E5D1C438-A423-4146-A0D3-9E314F5871B2
The EDITORS
Editor
December 17, 2018 at 8:16 pm