COVID-legal study: neurosurgeon experience in Britain during the first phase of the COVID-19 pandemic – medico-legal considerations

Abstract

Introduction: The COVID-19 pandemic has resulted in a significant number of changes to elective and emergency neurosurgical practice.

Materials and Methods: This paper reports the results of an online survey of Society of British Neurological Surgeons (SBNS) members undertaken between 10th and 24th of June 2020 regarding changes in consent practice in response to COVID-19, as well as the physical challenges experienced while operating under higher levels of personal protective equipment (PPE).

Results: Despite the real and substantial risks associated with COVID-19, 23% of surgeons reported they were not made any changes to their usual consent process, and 54% of surgeons indicated that they made reference to COVID-19-associated risks in their written consent documentation. 93% of neurosurgeons reported physical difficulties operating using PPE; 62% reported visors/goggles fogging up, 55% experienced ‘overheating’, 62% reported fatigue, and 82% of surgeons reported difficulty communicating with the theatre staff.

Conclusions: This survey highlights discrepancies in the consent practice between neurosurgeons which needs to be addressed at both local and national levels. The PPE being used in neurosurgical operations is not designed for use with specialist equipment (82% of respondents reported having to remove PPE to use the microscope) and the reported physical difficulties using PPE intraoperatively could significantly impact on both neurosurgeon performance and patient outcomes. This requires urgent attention by NHS procurement and management and should be urgently escalated to trust occupational health authorities as a workplace safety concern.

Keywords:

• Medico-legal practice
• neurosurgery
• COVID-19
• surgical consent
• patient safety

Acknowledgments

The authors wish to thank the Society of British Neurological Surgeons for their assistance in disseminating this questionnaire.

Author contributions

RF and PP conceived the study; RF, PP, and MDJ designed the survey: RF edited the survey; RF, MG, PP analyzed the results and wrote the manuscript; all authors reviewed and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).