Patient safety

This article approaches patient safety through how consent works, the team checks around a procedure, and the information given afterwards. It is not a list determining which procedure suits whom. Preparing for the consultation is covered in questions to ask before deciding, and verifying titles and a facility's documents in how to verify a specialist. Rather than setting those subjects out again, what is treated here is how a decision turns into records and communication over the course of a procedure.

How does informed consent work?

At the centre of informed consent is the consent of a person who has been informed about the subject and the consequences of the intervention to be carried out.¹ Article 31 of the Turkish Patient Rights Regulation makes that informing the essential basis; article 22 provides that, save for statutory exceptions, no one may be subjected to a medical procedure without their consent or in a manner not matching the consent they gave.¹ An account of consent therefore cannot be reduced to the question of whether a document was signed.¹

The NHS explains valid consent through voluntariness, being informed, and capacity.² In describing voluntariness it includes the absence of pressure from family or friends as well as from medical staff.² That is the institution's frame for explaining consent; the legal provisions in Turkey are dealt with below through the Patient Rights Regulation. No test of decision-making capacity for a reader to apply to themselves is offered here.

Article 24 of the regulation takes the patient's consent as the basis for a medical intervention, and separately governs permission from a guardian for a patient who is a minor or under legal restriction.¹ The same article requires that, even where the legal representative's consent suffices, the patient be heard so far as they can understand what is explained, and be enabled to take part in the decisions.¹ The presence of a representative therefore does not mean the patient is kept outside the process of being informed.¹

Taking the measures needed for people with disabilities to be informed, and to give consent, in a manner suited to their circumstances is a duty the same article places on facilities.¹ The form of the informing and participation in the decision are for that reason dealt with together.¹ The provision does not determine what a particular diagnosis means for suitability for surgery; what is described here is a person's participation in information and in the consent process.¹

What does a consent form cover, and what does it not?

Form and copies: Article 26 of the Patient Rights Regulation governs the preparation of a consent form in the circumstances the legislation provides for and for interventions medically considered likely to give rise to dispute.¹ Conveying the information in the form orally is part of the same provision.¹ The form is signed in 2 copies; one is placed in the patient's file and the other given to the patient or their legal representative.¹ The oral explanation and the document the patient keeps are thus not substituted for one another.¹

Validity and responsibility: The form is also signed by the health professional who gives the information and who will carry out the intervention; that professional is held responsible for the accuracy of the information given.¹ Article 28, for its part, does not tie consent to any particular form apart from the exceptions in the legislation.¹ The same article states that consent obtained contrary to law and morality is void and that no intervention may be made in reliance on it.¹ Read together, these provisions mean it cannot be said that every consent takes the same documentary shape; nor does it follow that, where a form is required, the oral informing may be skipped.¹

Limits of the intervention: The scope of consent is not unlimited either.¹ Article 31 covers the obligatory routine steps that are a continuation of the process the intervention requires, but requires the intervention to remain within the limits of the consent given.¹ The exception provided for extending a procedure is tied to a medical necessity where not extending it could lead to the loss of an organ or of its function.¹ That condition does not mean every additional step not discussed beforehand may be carried out on the physician's preference alone.¹

Emergency exception: Article 24 also provides an exception for emergencies where consent cannot be obtained, where there is danger to life and the patient is unconscious, and for interventions where an organ or its function is at risk.¹ Recording the situation, and informing a relative or legal representative at whatever stage is possible, are part of that provision too.¹ For interventions after consciousness returns, the consent procedures are resorted to again, depending on the patient's competence and ability to express themselves.¹

Consent for a planned procedure: These exceptions should not be read as general permissions that make the initial informing for a planned procedure unnecessary.¹ The scope of consent, routine continuation steps and emergency necessity are not the same thing; the regulation governs them under different conditions.¹ A signature on a form and an intervention later carried out falling within that consent are therefore separate matters.¹

What checks are made around a procedure?

In the NHS's account of preoperative assessment, the tests can vary with the operation and the kind of anaesthetic, and the assessment aims to identify medical conditions that may call for special care during or after the surgery.³ Making the medicines, vitamins and herbal supplements a person takes, and the results of previous tests, available to the assessment is also covered.³ That account is not turned here into an instruction to stop any medicine, request a new test, or apply the same preparation programme to everyone.

The World Health Organization's surgical safety checklist separates the checks made before anaesthesia is induced, before the skin incision, and before the patient leaves the operating room.⁴ Confirming identity, the planned procedure, the site and consent; checking known allergies and the anaesthesia equipment; and the team's preparedness for critical events are parts of that arrangement.⁴ The list is for teamwork in the operating room; it does not call for a score a patient calculates to authorise their own operation.⁴

The implementation manual stresses that the information is confirmed verbally within the team, and states that a checklist used solely as a written instrument is likely to be far less effective.⁵ Asking again about identity and the procedure is likewise explained in the manual as part of the safety confirmation.⁵ That repetition does not mean the information was never recorded before; it serves to have team members confirm the same procedure, person and site.⁵

At the exit stage, instrument and material counts, the labelling of specimens taken, and the key concerns for recovery and management are reviewed.⁴ The WHO also states that the checklist does not claim to cover every safety matter and that additions may be made to fit local practice.⁵ The aim here is not to present the existence of a list as a guarantee of the result, but to explain how care is handed over within the team.

Why is discharge information a separate stage?

The consent given for a procedure and the plan of care after it carry different information.¹ Article 24 of the Patient Rights Regulation provides that a patient whose inpatient treatment is complete has the plan covering their general state of health, their medicines, follow-up dates, diet and what they should do afterwards explained orally by a health professional.¹ That provision is written specifically for people whose inpatient treatment is complete.¹

The same paragraph also requires a copy of the discharge summary containing the plan to be given to the patient.¹ The explanation therefore does not remain only in the conversation held in hospital but also becomes a document the patient can take away.¹ Receiving a copy of the consent form and receiving the discharge plan are not substitutes for one another; the regulation provides for them at different stages.¹

The NHS's information about after surgery likewise deals with arranging care at home in advance, and with making clear the equipment needed and the information about wound care and pain management.⁶ Knowing who to contact where something at home causes concern is also within that frame.⁶ That is not an invitation to a particular facility but an explanation of the contact arrangement that belongs in discharge information.

This general guide does not give a shower, dressing, return-to-work or sport timetable applying to every procedure. The care information in the procedure articles is not converted here into a single common interval. The subject of this section is how that information is conveyed to the patient and which document it appears in, not a restatement of the practical detail.

Which records can be used for a second opinion?

The right to a second opinion itself is dealt with in the article on questions to ask before deciding. The practical basis here is article 16 of the Patient Rights Regulation; a patient may examine the file and records concerning their state of health, directly or through a proxy or legal representative, and may take a copy of them.¹ Examining your own health record and asking for a copy is for that reason not described as a suggestion left to the facility's discretion.¹

The provision gives a basis for a patient to obtain their own health records where they want them considered in another assessment.¹ At the same time, the same article limits who may see the records to those directly involved in the patient's treatment.¹ Nor does the article confine the right of examination to something only a legal representative may exercise; it expressly includes examination by the patient.¹ A person accessing their own file and the file being visible to everyone are different things; that limit is preserved here too.¹

When should you not wait?

Knowing the contact arrangement in advance does not mean every complaint waits for the planned follow-up date.^6,7 The NHS's information about blood clots treats signs suggesting a clot in the leg as among the situations requiring assessment, and marks out the need for emergency help where shortness of breath or chest pain accompanies them.⁷ No estimate of frequency, and no method of self-diagnosis from symptoms, is given here.

Blood clots: A clot forming in the leg veins and travelling to the lungs is serious.⁷ One-sided leg pain and swelling, sudden shortness of breath or chest pain need urgent assessment.⁷

The pulmonary embolism information of Koşuyolu Hospital, part of the Ministry of Health, states that emergency help should be sought at once for unexplained shortness of breath or chest pain.⁸ Emergency help is not held back while trying to reach your doctor; the emergency number is called.⁸ That sentence about emergency help belongs to the context of shortness of breath or chest pain above; it does not describe the same route for every complaint after surgery.

The NHS asks that, on leaving hospital, it be made clear who to contact if something at home causes concern.⁶ Care information therefore consists of more than a description of dressings or medicines; it also carries the information about who to turn to if there is a problem.⁶ Explaining planned care and not delaying over urgent signs are matters that complement one another.^6,7 The examples in this article are not presented as a list of symptoms covering every procedure.

References

1. Ministry of Health. Patient Rights Regulation. Official Gazette, 1 August 1998, no. 23420. Articles 16, 22, 24, 26, 28 and 31. saglik.gov.tr ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹ ↩¹² ↩¹³ ↩¹⁴ ↩¹⁵ ↩¹⁶ ↩¹⁷ ↩¹⁸ ↩¹⁹ ↩²⁰ ↩²¹ ↩²² ↩²³ ↩²⁴ ↩²⁵ ↩²⁶ ↩²⁷ ↩²⁸ ↩²⁹ ↩³⁰ ↩³¹ ↩³² ↩³³ ↩³⁴ ↩³⁵ ↩³⁶ ↩³⁷ ↩³⁸ ↩³⁹

2. NHS. Consent to treatment. Page last reviewed 8 December 2022. nhs.uk ↩ ↩²

3. NHS. Having an operation (surgery): Before surgery. Page last reviewed 9 July 2024. nhs.uk ↩ ↩²

4. World Health Organization. WHO Surgical Safety Checklist. 2009. who.int ↩ ↩² ↩³ ↩⁴

5. World Health Organization. Implementation manual WHO surgical safety checklist 2009: safe surgery saves lives. 2009. who.int ↩ ↩² ↩³ ↩⁴

6. NHS. Having an operation (surgery): After surgery. Page last reviewed 9 July 2024. nhs.uk ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶

7. NHS. Deep vein thrombosis (DVT). Page last reviewed 30 April 2026. nhs.uk ↩ ↩² ↩³ ↩⁴ ↩⁵

8. Ministry of Health, Koşuyolu High Specialisation Training and Research Hospital. Akciğer embolisi (Pulmonary embolism). saglik.gov.tr ↩ ↩²