Endoscopic Retrograde Cholangiopancreatography (ERCP) is a complex therapeutic procedure often requiring temporary stent placement. While clinical success hinges on technical skill, the quality of the consenting process is equally imperative for patient understanding, satisfaction, procedural safety and reduces medicolegal risk. Furthermore, if not removed or exchanged in a timely manner, retained stents can cause serious sequelae such as cholangitis, biliary obstruction, ductal damage, or perforation, while increasing length of stay and need for further investigations. In many institutions, the consent for ERCP often occurs on the day of the procedure, occasionally under significant time pressure. This practice can limit the opportunity for meaningful patient discussion, potentially reducing understanding, satisfaction and concordance. The primary aim of this project was to ameliorate the ERCP process via pre-consenting, as well as to develop a robust, integrated stent tracking system within the electronic patient record (EPR). 

A retrospective review was conducted over an 8-month period across two years (April 2024 – July 2025). All ERCP procedures were included and data was extracted from EPR and local audit records. Baseline measurements assessed the proportion of patients pre-consented prior to the day of procedure, with inpatient (IP) and outpatient (OP) sub-analysis. Pre-consent clinic slots were made available weekly. OP identified for ERCP were offered an appointment in this clinic, during which consent discussions were held and educational material provided. For IP, registrars consented patients during the admission. An enhanced ERCP patient information leaflet that included simplified explanations of procedure indications, risks, recovery expectations and contact information. The leaflet was reviewed and approved by the local endoscopy user group prior to implementation. A multidisciplinary working group involving endoscopy and the digital informatics teams convened to formulate a stent tracking tool within our EPR. Temporary stents and relevant data (type, date of insertion, planned removal date) were inputted and extracted into a live Excel tracker.

A total of 116 procedures were analysed and a marked improvement in pre-consenting rates was observed post intervention with pre-consenting rates increasing from 26% to 48%. OP pre-consent rates doubled from 28% to 55%, while IP completion also upgraded from 22% to 39%. Qualitative feedback from clinicians highlighted improved workflow efficiency, reduction in on-the-day administrative delays and enhanced patient understanding. Patients were reported to be more informed and confident during pre-assessment, allowing more meaningful discussions about risks, alternatives and expectations.The EPR-linked stent tracking module was successfully embedded, ensuring that every temporary stent inserted was logged for follow-up. Early post-implementation audit confirmed 100% accuracy of data capture for stent tracking fields, demonstrating the reliability of the digital workflow.

This service improvement initiative demonstrates that pre-consent can substantially improve preparedness for ERCP procedures. Pre-consenting represents more than an administrative step, it embodies patient-centred care. By providing information early, patients can reflect, discuss with family members and make informed decisions without time pressure. The redesigned pre-consent workflow and automated stent tracking support safer, more consistent pathways. Updates to the ERCP patient information leaflet, enhances access to clear, standardised information. The addition of automated stent tracking promotes continuity of care beyond the procedure and reduces risk associated with retained temporary stents, as well as being JAG mandated. Future steps include introducing patient-facing digital consent options and maintaining continuous audit cycles to ensure sustained improvement and patient-centred outcomes.