Remote Consent Platform As Part Of Regular Practice In Cataract Surgery In Public Health Care.

To demonstrate that using remote consent can be easily used by patients and clinicians. To compare the time spent with e-consent signed by the patients prior to surgery vs consent created on the day of the surgery. To determine patients’ and surgeons’ satisfaction when using electronic consent platforms.

Remote consent is being used in various services such as company contracts, banking, and legal documents.  However, public healthcare does not commonly include this option. In the NHS patients receive information and sign on the day or months prior to surgery.  Neither is ideal as both do not comply with the principle of a 2 step consent with a cooling off period in between. Signing on the day of surgery also incurs extended pre-op ward round time which affects the efficiency of operating lists.

We tested a remote consent platform during a 1-week-high-volume cataract drive. Patients were pre-selected based on cataract complexity and medical background. Patients verbally consented in clinics when listed. 2 weeks prior to operation, the platform was used to send patients a link to a consent form by SMS and email. Patients were then able to review risks and benefits of surgery to make informed decisions. The link allows electronic devices to become a signature pad, signature is captured electronically, and sent to hospital. A time-motion study was done to measure the efficiency of using the platform on the day of surgery to either confirm or re-sign consents.  Also, a survey was collected from patients and surgeons on the ease of use.

50 women and 30 men, 45 to 90 years old were included. 75 patients used remote consent. 48% signed before the cataract drive week 52% signed on the surgery day. The average time to verify consents already signed was 19 seconds. The average time for patients to sign in on the day was 1’33’’. The average time to register a patient for consent was 2’30’’. 60 patients answered the questionnaire about remote consent. 83%  found it either somewhat easy or very easy to use, 97% were somewhat satisfied or very satisfied with the digital process, and 94% would likely or very likely recommend it. Regarding surgeons: 100% were very satisfied or somewhat satisfied with the process, and 100% likely or very likely to recommend it to another clinician.

Remote consent is extensively used by several public and private institutions. However, it is not yet popular in public health services, even if it can optimize diverse processes. In the cataract drive, the majority of patients found the technology easy to access and use, and were satisfied using the remote consent. Surgeons were also very pleased with the process. In this local cataract drive, we found the remote consent process to be time-saving. Although there are aspects that can still be refined, such as informing the patients about receiving a message with the link to the consent, technical issues which could delay the process, and digital exclusion, we consider remote consent a promising tool to be used in public health practice.