Healthcare providers working in poorly equipped emergency departments within low-income countries frequently encounter difficulties when trying to secure informed consent from incapacitated individuals or their family members. These situations are usually marked by severe time pressure and occur in highly crowded conditions. For this reason, the current study set out to examine the actual informed consent procedures followed by medical professionals during emergency surgical interventions in two emergency surgical departments at two major teaching hospitals in Uganda. From October 2022 to February 2023, key informant interviews were performed in Uganda. Sixteen staff members were deliberately chosen from the surgical emergency teams at these two tertiary teaching hospitals. In addition, the research team directly observed how informed consent was being carried out in practice. All collected data were organized and examined inductively through NVivo version 12. Analysis of the key informant interviews revealed six central themes: staff knowledge and opinions concerning informed consent; the steps, routines, and real-world application of consent procedures; methods used to communicate during consent; ethical aspects involved; perceived advantages of obtaining consent in surgical emergencies; and the various obstacles faced when seeking emergency consent. Although the participating staff demonstrated reasonable understanding of informed consent principles, they reported facing numerous practical difficulties, largely due to the lack of formal institutional guidelines. In general, the consent process was unsatisfactory at both facilities. Basic elements such as greeting the patient, clearly outlining risks, and verifying comprehension were consistently performed inadequately. Discussions occurred in loud, disruptive surroundings at both locations, and the public hospital offered no private space whatsoever for these conversations. While emergency personnel at both institutions demonstrated solid theoretical knowledge of consent requirements, real-world application revealed major shortcomings, particularly in explaining risks and ensuring that patients or relatives fully understood the surgical procedure, including its potential risks and benefits. Staff emphasized the urgent need to develop standardized, procedure-specific consent documents that clearly record the information shared with the patient. They also called for official policies addressing consent in cases involving incapacitated patients who have no available surrogate decision-makers.
