Interestingly, many physicians who responded to our questionnaires appear to use the hospital admission blanket consent form to cover invasive medical procedures performed during the hospital stay. We suspect that permission to give transfusions in the perioperative period is part of some surgical consent forms and may account for the rate (36%) of separate consent obtained for transfusions reported by surgical intensivists. Insofar as a patient’s condition varies and is an important determinant of the risk of each procedure, blanket consent (to general treatments) at hospital admission may not adequately inform the patient about risks. We invited those using such a strategy to send us their blanket consent form, but no respondent sent a form. We suspect that the general (nonsurgical) hospital admission consent-to-treat form for most institutions is similar to ours. That form does not list specific procedures, risks, benefits, and alternatives that might be undertaken during hospitalization/critical illness. Such general blanket consent may not satisfy the criteria of informed consent as outlined in the Belmont report.
This study has at least three important limitations. First, the method of national sampling is unlikely to represent a broad crosssection of clinical practices. The study did not examine the practices of hospitals without teaching programs. Second, the response rates of the two national questionnaires, fair (27%) for critical care directors and poor (5%) for medicine directors, could contribute to significant reporting bias. Nonetheless, data from the state of Connecticut (where almost all ICUs were surveyed) included many institutions that were not university-affiliated, and consent practices were not dissimilar to the national sample. Finally, response patterns suggest that some (as many as nine) internists may have interpreted the questionnaire to ask how many unique consent forms they use (rather than for which procedures they go through the process of obtaining consent). Aside from these nine respondents, the patterns of other respondents suggest that they understood the intent of the question, but the frequencies listed in the internist’s questionnaire may underestimate (by roughly 15%) the true frequencies at which internists obtain consent for various procedures. These shortcomings notwithstanding, this study demonstrates a relative lack of consensus regarding whether the obtaining of separate informed consent is required for many common medical procedures.