Online Consent for Epidurals

[J42]

Myself and a colleague are writing a business proposal for online advance consent for labour epidurals (to be submitted to Mersey Tertiary Obs Hospital). The aim is to create an interactive website to be accessed by pregnant patients, giving information about options for their pain relief in labour. It must test their understanding of the information given and ultimately result in valid consent for an epidural, if that is their chosen option. The consent part is the innovation in the proposal. The site needs to allow:

• Confidential access by the patient and site security
• Provision of up to date, accurate information (written, videos and in different languages)
• Patient reflection and checking of understanding (MCQs)
• Valid, advance Consent

I've had advice from large organisations such as MMT for development of a bespoke (expensive!) system for this. I've also had advice from a friend regarding cheaper open source solutions. Obviously the proposal is nothing without a solid explaination of the practical aspects of how a system like this can be developed, and the means to do it. I was wondering if you may be able to give me further advice on how to develop a system like this, whether it could be put on current NHS servers, cost etc?

[Grant]

I circulated your ideas to the SCATA committee with a link to your post above. I'll copy any replies here so that we can keep the discussion going.
No doubt the NHS would want to know what financial benefits the project would bring before committing any funding to it. These benefits might be difficult to quantify
In terms of design, deployment and support, SCATA can certainly advise on that. Whatever technical solution you opt for, there will be recurring costs so a source of ongoing funding needs to be identified. If not the NHS, then you'd be looking at either charitable funding or some other business model e.g. Google Ads.
Personally I think it's a great idea. Have you thought about support from the OAA ?

[J42]

Thanks Grant.
In the business plan we do describe that the consent project would unfortunately not generate profit, and it is difficult to estimate cost savings if any. However, the time a doctor spends consenting a patient for an epidural would be saved, allowing him to be available sooner for his next patient, and reducing waiting time, thus conforming to the national standard relating to response times for epidural requests (30 minutes as the norm and more than one hour only in exceptional circumstances). It remains to be seen but the process could potentially save money spent on litigation if the process was shown to reduce the amount of claims being brought. It is worth noting however that claims in this area do not amount to a great deal in comparison to other areas of obstetric practice. NAP3 numbers for complications from Obstetric Epidurals was low. Obstetrics accounted for 45% of all UK CNB, of which <14% resulted in serious harm (1 abscess, 2 nerve injures, 1 subdural haematoma). Yentis et al presented an analysis of claims against the NHS between 1997-2005 relating to regional anaesthesia (published 2010), of which there were 336. Approximately half of the claims (186/366; 51%) were related to obstetric anaesthesia and analgesia. The total cost for obstetric closed claims was £5 433 920. The dataset provides a useful indication of the extent and cost associated with the obstetric claims.
Ultimately however, the aim of this proposal is to improve patient and doctor satisfaction with the consent process for epidural analgesia during labour, and for that the cost is justified?!
We carried out a survey on 100 women post labour who had received an epidural. The results support the proposal. Only 30% recalled the risk of paraplegia/ spinal cord damage or nerve damage. Even fewer recalled the other risks. 70% said they would use an advance consent process.
We were thinking of submitting this at a Trust level first rather than applying to the entire NHS?
I don't really know what the next move should be... it's all dressed up with nowhere to go!

[Grant]

Hi Emma
The SCATA committee discussed your proposal at our net meeting on Monday.
The outcome was :

The members present supported the outline project fully
There was agreement that SCATA funds could be made available to support development and/or technical services in the form of a grant (the grant application form is on the web site if you need it)
The issue of ongoing funding assuming a successful pilot is more difficult and SCATA could not commit to that but it was suggested that the OAA may have resources that could be applied for
It was suggested that the next step might be Paper Prototyping http://en.wikipedia.org/wiki/Paper_prototyping
A local SCATA contact for the project might be Dr Todd Wauchob (won't publish his email here but I can send to you privately)
On the basis of the paper prototyping, SCATA could provide resources to host a development web site for a limited time at no cost
SCATA has resources in terms of web developers that could build and deploy a pilot site but their time would have to be paid for
Independent developers would be welcome to use the SCATA resources but it's unlikely that you could find developers that will work for free. SCATA would be willing to commit grant money to pay for developer's time but this would be a fixed amount and the IP rights would be retained by SCATA.

I hope this is useful. Let me know how/if you want to proceed and we can discuss the next steps.

[Grant]

BTW did you see this :
http://onlinelibrary.wiley.com/doi/10.1016/S0091-2182%2897%2900055-4/abstract
Comes #1 in a Google search for "online consent for epidurals".
This forum topic is #2

[J42]

That's great news, and thank you for the advice.
I'm awaiting the outcome from the next OAA committee meeting in October, where the E consent proposal document will be discussed. We've sent Dr Wauchob the same document. I'll post again when the OAA return to me with their final verdict. Fingers crossed!

[J42]

Another quick question.. would NHS Connecting for Health, and Enterprise Wide Arrangements (lowest cost purchasing power for software etc) be utilised in the construction of this site? Or would it be an independent venture?

[pcooper]

I think you are quite a long way from deciding what software any eventual project/website will run on .
Once the information you are wanting to get over and how you anticipate the users will access it and navigate from one thing to the next is worked out, that is then the stage of seeing what software is needed.


BUt in general I think EWAs are in the past as far as NHS is concerned.

get in touch with Tod and he can help you wit the next step

[J42]

Thank you. We plan to see Dr Wauchob after the OAA have reviewed our project in October, so that at that stage we have all the appropriate input. I wanted the proposal to be as thorough as possible before submitting it to the OAA, with every step of the project laid out and all areas covered, hence my questions above. Will be in touch! Emma