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Preventing Abuse of Overlapping Surgeries

SurgeryThe 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.

The 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.