ImportanceMany health systems use electronic consent (eConsent) for surgery, but few have used surgical consent functionality in the patient portal (PP). Incorporating the PP into the consent process could potentially improve efficiency by letting patients independently review and sign their eConsent before the day of surgery.ObjectiveTo evaluate the association of eConsent delivery via the PP with operational efficiency and patient engagement.Design, Setting, and ParticipantsThis mixed-methods study consisted of a retrospective quantitative analysis (February 8 to August 8, 2023) and a qualitative analysis of semistructured patient interviews (December 1, 2023, to January 31, 2024) of adult surgical patients in a health system that implemented surgical eConsent. Statistical analysis was performed between September 1, 2023, and June 6, 2024.Main Outcomes and MeasuresPatient demographics, efficiency metrics (first-start case delays), and PP access logs were analyzed from electronic health records. Qualitative outcomes included thematic analysis from semistructured patient interviews.ResultsIn the PP-eligible cohort of 7672 unique patients, 8478 surgical eConsents were generated (median [IQR] age, 58 [43-70] years; 4611 [54.4%] women), of which 5318 (62.7%) were signed on hospital iPads and 3160 (37.3%) through the PP. For all adult patients who signed an eConsent using the PP, patients waited a median (IQR) of 105 (17-528) minutes to view their eConsent after it was electronically pushed to their PP. eConsents signed on the same day of surgery were associated with more first-start delays (odds ratio, 1.59; 95% CI, 1.37-1.83; P < .001). Themes that emerged from patient interviews included having a favorable experience with the PP, openness to eConsent, skimming the consent form, and the importance of the discussion with the surgeon.Conclusions and RelevanceThese findings suggest that eConsent incorporating PP functionality may reduce surgical delays and staff burden by allowing patients to review and sign before the day of surgery. Most patients spent minimal time engaging with their consent form, emphasizing the importance of surgeon-patient trust and an informed consent discussion. Additional studies are needed to understand patient perceptions of eConsent, PP, and barriers to increased uptake.

中文翻译：

---

通过患者门户提供电子手术同意书，以提高围手术期效率


重要性许多卫生系统使用电子同意书 （eConsent） 进行手术，但很少有人在患者门户 （PP） 中使用手术同意功能。将 PP 纳入同意流程可能会通过让患者在手术前独立审查和签署他们的电子同意书来提高效率。目的评估通过 PP 提供 eConsent 与运营效率和患者参与度的关联。设计、设置和参与者这项混合方法研究包括回顾性定量分析（2023 年 2 月 8 日至 8 月 8 日）和对实施手术 eConsent 的卫生系统中成年手术患者的半结构化患者访谈（2023 年 12 月 1 日至 2024 年 1 月 31 日）的定性分析。统计分析于 2023 年 9 月 1 日至 2024 年 6 月 6 日期间进行。主要结果和措施从电子健康记录中分析了患者人口统计学、效率指标（首次开始病例延迟）和 PP 访问日志。定性结局包括来自半结构化患者访谈的主题分析。结果在 7672 名符合 PP 条件的独特患者队列中，生成了 8478 份手术电子同意书（中位 [IQR] 年龄，58 [43-70] 岁;4611 [54.4%] 女性），其中 5318 份 （62.7%） 在医院 iPad 上签署，3160 份 （37.3%） 通过 PP 签署。对于所有使用 PP 签署 eConsent 的成年患者，患者在电子推送到 PP 后等待 105 （17-528） 分钟才能查看他们的 eConsent。在手术当天签署的 eConsent 与更多的首次开始延迟相关（比值比，1.59;95% CI，1.37-1.83;P < .001）。 患者访谈中出现的主题包括对 PP 的良好体验、对 eConsent 的开放性、略读同意书以及与外科医生讨论的重要性。结论和相关性这些发现表明，包含 PP 功能的 eConsent 可能允许患者在手术前进行审查和签名，从而减少手术延误和工作人员负担。大多数患者花了最少的时间参与他们的同意书，强调了外科医生与患者之间的信任和知情同意讨论的重要性。需要更多的研究来了解患者对 eConsent 、 PP 的看法以及增加接受率的障碍。