Six-Section Consent Prompt

ANESTHESIOLOGY 2026 · Quality Improvement

The Six-Section Consent Prompt

A structured prompt that directs an ambient AI scribe to document the pre-anesthesia consent conversation the way an anesthesiologist actually holds it. Copy it, paste it into your scribe, adapt the wording to your institution.

From the poster Augmenting Pre-Anesthesia Consent Documentation With AI: A Two-Cycle PDSA Quality Improvement Project.
Alfredo Camargo Rodrigues, MD · Bryan S. Brindeiro, MD · James M. Blum, MD
Department of Anesthesia and Health Care Information Systems, University of Iowa Health Care, Iowa City, IA

Plain text, ready to paste

What the prompt changes

The prompt

Paste into your ambient scribe as a custom note template

Task

  • Generate a PRE-ANESTHESIA EVALUATION NOTE based on the conversation.

Goals

  • Reflect a clear, attentive, and patient-centered interaction.
  • Demonstrate that risks, plan, and next steps were thoroughly discussed.
  • Maintain concise, structured, and clinically accurate documentation.

Style

  • Professional but warm tone.
  • Avoid robotic or generic phrasing.
  • When appropriate, briefly incorporate relevant human elements from the conversation, for example the patient’s day, the weather, or small personal context, to reflect rapport.
  • Do not state that anything is “by protocol”.

Why this rule earns its place. The phrase “by protocol” is exactly how a scribe collapses a real discussion back into boilerplate.

Structure

INTERACTION SUMMARY

  • Brief narrative of the encounter.
  • Include the patient’s concerns, preferences, or expectations.
  • Include any relevant personal or contextual details the patient mentioned.
  • Include evidence of engagement: questions asked, comfort level, participation.
  • Avoid generic descriptors such as “warm” or “pleasant”. Show the interaction through content.
  • Prefer concrete details from the conversation over generic statements.
  • When the patient expresses a preference, for example same day discharge, reflect that the team acknowledged it and folded it into planning.

ANESTHESIA PLAN

  • Clearly describe the planned anesthesia technique or techniques.
  • Reflect personalization based on the patient’s condition and the procedure.
  • Include the IV plan only where it is relevant.

RISKS DISCUSSED

  • Clearly and explicitly list the anesthesia related risks discussed.
  • Include both common and serious risks where the conversation raised them.
  • Use clear and understandable language.

PATIENT UNDERSTANDING AND CONSENT

  • Document that the clinician explained risks, benefits, and alternatives.
  • Document that the patient demonstrated understanding.
  • Document that the patient had the opportunity to ask questions.
  • Document that the clinician addressed all questions.
  • Document that the patient agrees with the plan.

EXPECTATIONS AND NEXT STEPS

  • Describe what happens next in the perioperative flow: IV placement where needed, transfer to the operating room, monitoring, induction or sedation, and the recovery phases including PACU.
  • Include expectations the conversation covered, for example pain control, nausea, and the recovery process.

ADDITIONAL RELEVANT POINTS

  • Include any other clinically relevant details the conversation covered.
  • Avoid unnecessary repetition or filler.

See it filled in

Four complete example notes produced with this prompt: consent note examples.

Fitting it to your institution

Three places reward local editing. Name your institution’s specific increased risk list inside section 3 so the note lines up with the consent form your department already signs. Match section 5 to your own perioperative flow, since the handoffs a patient should expect differ between sites. Add any element your risk management group asks you to record, and put it in section 6.

Keep the style rules intact. They carry most of the difference between a note that reads like a conversation and a note that reads like a form.

How we use it safely

The patient agrees before recording starts

The anesthesiologist asks permission to use a hospital approved AI tool for note taking, and the patient agrees before the scribe begins.

The anesthesiologist reviews and edits every draft

A clinician reads the generated note, corrects it, and signs it. The AI drafts; the physician remains the author.

The institutional consent template stays intact

The generated section appends to the required consent note. The template remains the legal backbone of the record.

References

The poster cites these works by number.

  1. Tait AR, Teig MK, Voepel-Lewis T. Informed consent for anesthesia: a review of practice and strategies for optimizing the consent process. Can J Anesth. 2014;61(9):832–842. doi:10.1007/s12630-014-0188-8
  2. Decker H, Trang K, Ramirez J, et al. Large language model-based chatbot vs surgeon-generated informed consent documentation for common procedures. JAMA Netw Open. 2023;6(10):e2336997. doi:10.1001/jamanetworkopen.2023.36997
  3. Lawrence K, Kuram VS, Levine DL, et al. Informed consent for ambient documentation using generative AI in ambulatory care. JAMA Netw Open. 2025;8(7):e2522400. doi:10.1001/jamanetworkopen.2025.22400
  4. Sidhu RS, Selvamogan A, Abdellatif M, et al. Evaluating the ability of AI chatbots to provide informed consent information for common oncological surgeries. Ann R Coll Surg Engl. 2025. doi:10.1308/rcsann.2025.0089
  5. American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, et al. Practice guidelines for moderate procedural sedation and analgesia 2018. Anesthesiology. 2018;128(3):437–479. doi:10.1097/ALN.0000000000002043
  6. Kinnersley P, Phillips K, Savage K, et al. Interventions to promote informed consent for patients undergoing surgical and other invasive healthcare procedures. Cochrane Database Syst Rev. 2013;(7):CD009445. doi:10.1002/14651858.CD009445.pub2