The practice of overlapping surgeries is prone to abuse, according to a
new study in the
Journal of the American Medical Association (JAMA). We agree that reforms are needed to improve transparency and accountability,
as well as to prevent medical errors.
Overlapping v. Concurrent Surgeries
The term “overlapping surgery” refers to when the same surgeon
performs two procedures, and the start of one surgery overlaps with the
end of another. In most cases, a surgical resident completes the noncritical
aspects of the first surgery while the primary doctor proceeds to the
next procedure. In contrast, the term “concurrent surgery”
refers to surgeries in which the “critical parts” that the
primary surgeon is responsible for occur simultaneously.
Regulators, hospitals, and medical boards generally agree that doctors
should not perform concurrent surgeries due to patient safety and ethical
concerns. However, overlapping surgeries still occur frequently. The length
of surgical overlap and the extent to which non-critical parts of the
procedure are delegated also vary greatly from hospital to hospital.
In response to
controversy over the incidence of concurrent surgeries at top hospitals, the American College of Surgeons (ACS) revised its policies to clarify
that, although concurrent surgery is “inappropriate,” overlapping
surgeries may be performed so long as the primary surgeon or another attending
is “immediately available,” “qualified practitioners”
perform the noncritical parts, the scheduling does not “negatively
affect the seamless and timely flow of either procedure,” and the
patient provides informed consent.
Concerns About Overlapping Surgeries
As highlighted in the recent study, the impact of overlapping surgeries
on patient safety has not yet been sufficiently examined. Nonetheless,
many patients are understandably uncomfortable with the prospect of a
trainee performing large parts of their procedures and the
associated risk of medical negligence.
authors of the JAMA article, Michelle M. Mello and Dr. Edward H. Livingston, cite a recent study evaluating
patients’ perceptions of overlapping surgeries. It revealed that
most of the patients surveyed were unfamiliar with the practice. In addition,
44% reported that, had they known the surgeon was scheduling overlapping
surgeries, they would not have chosen that surgeon. Another 78% would
wait up to a month longer to have a non-overlapping surgery.
The authors recommend several steps that hospitals can take to restore
public trust in overlapping surgery:
- Perform strong, randomized, prospective observational studies.
- Inform patients about scheduling practices well before the surgery date.
In this disclosure, include information about how likely an overlap is,
who will perform the operation (and what their qualifications for doing
so are), as well as the patient’s options if there is any objection
to scheduling. Make sure the patient knows he/she has a right to request
that the surgery be performed at a different hospital or at a later date.
- It is the hospital’s responsibility to ensure that its surgeons fulfill
their responsibility to personally perform critical parts of the operation.
Failure to do so is seen as an act of noncompliance with federal billing
regulations and puts patients at unacceptable risk.
The authors specifically raise concerns over the fact that doctors are
allowed to determine which parts of a surgery are critical and, therefore,
require their attendance. “Giving surgeons authority to unilaterally
declare what the critical parts of an operation are does not work, as
evidenced by the repeated episodes of billing fraud, retaliation against
whistleblowers, and loss of public trust,” the authors write.
To improve accountability, the study recommends that “a multidisciplinary
committee within the hospital” establish the critical portions of
surgeries. It also calls for hospitals to create policies for overlapping
surgeries that require doctors to clock in and out of procedures and mandate
the circumstances under which surgeons must be ready to assist should
complications arise. “After staff are educated about the policy,
adherence must be documented and actively monitored,” the authors
state. “These steps can do much to ensure that abuses of overlapping
scheduling do not further undermine public trust in the practice of surgery.”
As San Diego medical malpractice lawyers, we are concerned that some medical
facilities are putting profits ahead of the interests of patients by performing
as many surgeries as possible. We encourage patients to verify which parts
of their procedures will be performed by the primary surgeon and raise
any concerns that you may have about the scheduling of your operation.
If you or someone you love has been seriously injured by a medical error,
don’t hesitate to contact a San Diego medical malpractice attorney
at the Law Offices of Robert Vaage for a free consultation.