ED Bedside Procedures
Consent and Time-Out Requirements
| Bedside ED Procedure | Consent Required | Time-Out Required | |
|---|---|---|---|
| Verbal Consent Only | Written Consent | ||
| Abscess I and D | Y | — | N |
| Arterial line | Y | — | N |
| Arthrocentesis | Y | — | N |
| Blood transfusion | — | Y | N |
| Central line | — | Y^ | Y^ |
| Chemical cardioversion (adenosine) | — | Y^ | Y^ |
| Complex laceration (multi-layered, tendon involvement, partial amputation) | — | TBD given circumstances & provider judgment | TBD given circumstances & provider judgment |
| Electrical cardioversion | — | Y^ | Y^ |
| ENT scope | Y | — | N |
| External ventricular drain placement | — | Y | Y |
| Foreign body removal (Nose, ear, vagina, rectum) | Y | TBD given circumstances | TBD given circumstances |
| Fracture reduction (closed) | Y | — | N |
| Intraosseous access | — | Y^ | N |
| Joint dislocation reduction | Y | — | Y |
| Laceration (minor) | Y | — | N |
| Lateral canthotomy | — | Y^ | Y |
| Lumbar puncture | — | Y | N |
| Paracentesis | — | Y | N |
| Pericardiocentesis | — | Y^ | Y^ |
| Peritonsillar abscess incision and drainage | Y | — | N |
| Procedural sedation | — | Y | Y |
| Regional nerve block | — | Y | Y |
| Removal of central line | Y | — | Y |
| Splinting | Y | — | N |
| Thoracentesis/thoracostomy | — | Y^ | Y^ |
| Tracheostomy tube exchange | Y^ | — | N |
| Traction pin | Y | — | N |
Key Notes & Exceptions:
- ^ Indicates Unless emergent.
- Procedures generally require direct attending supervision.
Notes from Policies
Written Consent Policy Docs
Emergency Consent
Only emergency patient care treatment or procedures are performed before obtaining general consent. For the purposes of this policy, an "emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, psychiatric disturbances and/or symptoms of substance abuse, such that the absence of immediate medical attention could reasonably be expected to result in:
- Placing the health of the individual in serious jeopardy;
- Serious impairment to bodily functions; or
- Serious dysfunction of any bodily organ or part.
“In an emergency situation where consent of the patient cannot reasonably be obtained before providing health care services, there is no requirement that a health care provider obtain a previous consent.” See KRS 304.40-320. In this case, the consent of the patient is implied.
Special Consent (Operative Permit)
A special consent, sometimes called an operative permit, is specific in nature and is obtained in addition to the general consent before a procedure that involves substantial risk is performed upon the patient. Any doubts about the necessity of obtaining a special consent from the patient are resolved in favor of procuring the consent.
Scope of Bedside Special Consent: Procedures performed at the bedside, in a procedural area, or ambulatory setting which require an injection for local or regional anesthesia, manipulation of an extremity or joint, placement of a tube or drain, drainage of body fluid, or removal of a foreign object, including previously placed medical devices, except to the extent informed consent is otherwise documented elsewhere; consent for subsequent removal of any tube, device, drain or other item is implied unless circumstances require a special consent.
Time Out Policy Docs
This policy applies to all operative and invasive procedures that are performed in any setting, and that expose patients to more than minimal risk. Procedures that involve puncture or incision of the skin, insertion and removal of an instrument or foreign material into the body through a natural orifice or other insertion site are included within the scope of this policy.
Performing Time Out: The purpose of a time out is to conduct a final assessment to verify that the correct patient identity, surgical or procedural site, and procedure to be done are identified; and that all relevant documents, information, and necessary equipment are available.
- A time out is performed immediately before starting the procedure.
- Time out is required for emergency procedures with the exception of life-threatening emergencies.
- A time out is performed before removing a central venous catheter from a patient, as per policy A03-065 (Placement and Maintenance of Percutaneous Vascular Catheters).
- The individual performing the procedure is responsible for the complete documentation of the time out.
- If a nurse or technologist is involved with the procedure, he/she may document the appropriate variables on the time out note; otherwise, the person performing the procedure must document the pertinent data.
-
The team collaboratively and verbally affirms the following are correct:
- Correct patient identity confirmed by patient name and birth date on the armband and procedure consent;
- Correct procedure, position, side, and site according to the procedure consent and relevant images;
- The presence of relevant images and results that are properly labeled and appropriately displayed;
- Administration of prophylactic antibiotics per protocol prior to induction;
- The need to administer fluids for irrigation purposes;
- Correct implants, equipment, or other requirements;
- Safety precautions based on patient history of medication use; and
- ABO compatibility for patients undergoing transplantation.
- The individual performing the procedure is responsible for the complete documentation of the time out.
- If a nurse, dental assistant, or technologist is involved with the procedure, he/she may document the appropriate variables on the time out note; otherwise, the person performing the procedure must document the pertinent data.
-
The team collaboratively and verbally affirms the following are correct:
- Correct patient identity confirmed by two patient identifiers or the patient armband, and procedure consent; and
- Correct procedure, position, side, and site according to the procedure consent and relevant images.