Wouter Leclercq

Chapter 4 68 DISCUSSION A previous study demonstrated that SIC is poorly implemented in the daily practice of Dutch general surgeons. 3 One explanation was a possible high percentage of (semi-) acute procedures in general practice. Conversely, as procedures in the orthopaedic and plastic surgical fields are mainly elective, it was hypothesized that the process of SIC would be better implemented in these two groups. However, the knowledge in the OS and PS groups were not better compared to GS (checking for competence OS 51%, PS 55%, GS 62%; recording of consent OS 79%, PS 75%, GS 88%). In daily practice this same observation can be made. To our surprise, the OS and PS asked less often for consent, even in elective cases, compared to GS (OS 38%, PS 32%, GS 49%); moreover, a pre-operative check if consent was adequately provided by the patient was at least equally worse (OS 37%, PS 32%, GS 46%). This same observation can be made in almost all questions asked. There was one exemption: Slightly more respondents in this study reported to have a standard operating procedure (SOP) for SIC in their department (OS 66%, PS 69%, GS 61%). Results of the present study generally indicate that knowledge and daily skills of SIC are also limited in both orthopaedic and plastic practices. Moreover, surgeons and residents performed equally poorly. Most European law countries (including the Scandinavian) have strict laws on patient rights and SIC. Previous studies show low knowledge scores on most issues concerning SIC, and consequently, daily practice is suboptimal. 3,13 In many studies the use of SOPs, tools and standard forms enhances the quality of patient care. 5,6,14 In this study, knowledge was poor and the daily practice results were substandard. Improvement of the SIC process in the orthopaedic and plastic surgical field is required. Solutions to improve the quality of the SIC process are available. Better training for medical staff should enhance the knowledge on SIC and should be implemented in surgical traineeships; introduction of best practice SOPs, adequate tools and standard SIC forms should enhance daily practice. SIC forms can aid medical staff during the SIC process if designed properly. 15-17 In the PS group 42% already used SIC forms, compared to 21% of the OS group. The use of interactive online SIC programs might be the next leap forward. 3,9 Many respondents were interested in using interactive tools to aid the SIC process. We have developed an online SIC program for patients referred for several procedures such as blepharoplasty, basal cell carcinoma of the skin, breast reduction surgery and inguinal hernia repair. These programs will be tested in upcoming trials to test feasibility in daily practice.