Combined procedures
A ‘combined procedure’ consent episode is one that is generated from more than one Concentric template. Although we use the term ‘procedure’, this functionality also applies to non-procedural use cases, such as chemotherapy regimens.
Example scenarios where a combined procedure would be used in Concentric are:
- Total abdominal hysterectomy + salpingo-oophorectomy
- Carboplatin + Paclitaxel
- Diagnostic laparoscopy +/- appendicectomy
Creating a ‘combined procedure’ consent episode
With an infinite number of possible combinations, and a broad spectrum of how common different combinations are, there are 2 key approaches to get to the consent information required for a combined procedure:
Scenario 1: Common combinations
Where a combination is commonly seen, our template search bar is trained to identify the combinations and present them as a search result, for example:
Whilst searching, if Concentric identifies a template that is commonly added to one of the search results it presents this as a ‘quick add’. Clicking the ‘quick add’ result adds this to your search.
By default, search results display a ‘+’ relationship between elements, but this can be edited on the subsequent page; see the customise section below for more details.
Scenario 2: Unknown combinations
Where a combination is not known by Concentric’s template search bar a different approach can be used to combine templates.
If the combination is not known to the search bar a message is shown to state that fewer elements should be selected initially:
In this example ‘total knee replacement’ should be selected followed by clicking ‘Customise’ on the subsequent page:
This brings up several options, including searching and adding an additional Concentric template:
To minimise repetition, combinations not recognised by Concentric’s template search bar but frequently created by a clinician can show within the user’s ‘common treatments’ section:
Customise: names, +/-, different sides, or add/remove elements
The ‘customise’ section offers several options, including editing component names, changing to ‘+/-’ (i.e. the component may or may not be done, most often depending on findings during the procedure), stating the side of each component, changing the ordering, and adding or removing components.
For example, here is a scenario where two components have been added, one as a ‘+’ and another as a ‘+/-’, a side has been stated, and a procedure name is being edited. On the right-hand side are buttons to change the ordering or remove a component.
Clinician view template information
Concentric merges the consent templates for the selected components and by default applies the following logic:
- The treatment descriptions are added in series
- Clinician concepts (indications, risks etc.) that exist on any of the selected components’ templates are shown
- Duplicate risks are displayed only once, appearing in the earliest stated timing bucket, and with the highest likelihood indicated
It is possible for additional logic to be applied to stated combinations, for example to remove indications and alternatives that are not relevant in such clinical scenarios. Combined procedure logic has been applied to some high-volume combinations. Additional logic can be requested via the clinical content update process.
Clinical safety note:
Given the infinite number of possible combinations, clinicians should assume that the template generated for a combined procedure has not been reviewed by another clinician. Therefore, additional care should be applied to ensure the information is complete, accurate, and appropriate for the individual patient.
Patient-facing views
Combined procedures follow the same workflow as single template episodes; the components are not presented separately to the patient and consent is given for all components at the same time. For example, the description in consult view presents each component in series:
