Becker's Clinical Quality & Infection Control

53 SURGICAL SAFETY Feds Seek Information on Concurrent Surgeries at 20 Medical Facilities: 6 Things to Know By Kelly Gooch T wenty hospitals and health systems in the United States were asked to describe their policies for concurrent surgeries, when a surgeon runs two opera- tions at the same time, according to a Pitts- burgh Post-Gazette report. e request came via a fact-finding letter from the U.S. Senate Finance Committee. Here are six things to know about the inquiry. 1. e committee declined to provide the Pittsburgh Post-Gazette with a list of med- ical facilities receiving the letter. 2. In the letter, signed by committee chair- man Sen. Orrin Hatch (R-Utah), federal officials do not accuse any organization of wrongdoing, or suggest any hospital is under investigation, according to the report. How- ever, the letter does request detailed informa- tion about the organizations' monitoring and oversight of the practice and, in particular, whether patients are told if they're sharing their surgeon with someone else, according to the Pittsburgh Post-Gazette. 3. "We are especially concerned by reports that in some cases, steps have been taken to actively conceal this practice from patients," the letter states, according to the report. 4. e letter appears to have been prompted, at least partly, by stories published in e Bos- ton Globe over the last several months, which detail disagreements within the medical community about the propriety of physicians performing concurrent surgeries, the Pitts- burgh Post-Gazette reported. 5. e Boston Globe reports include instances where the surgeon is unavailable during urgent situations, as well as instances where a patient was kept under anesthesia for an extended pe- riod or suffered damages because the surgeon was not present, according to the report. 6. CMS allows surgeons to bill for concurrent surgeries under certain circumstances and requires an attending physician's presence during critical portions of the operations. n New Guidelines Say Surgeons Should Inform Patients of Concurrent Procedures By Shannon Barnet T he American College of Surgeons issued new stan- dards April 13 for surgeons performing procedures simultaneously. While the ACS doesn't prohibit the practice outright, the guidelines do suggest informing the patients involved. According to the ACS standards, "A primary attending sur- geon's involvement in concurrent or simultaneous surgeries on two different patients in two different rooms is not ap- propriate." That said, there are two circumstances in which portions of two procedures may overlap. The first, and most common, scenario is when the most critical parts of the first operation have been completed and there is no foreseeable need for the primary attending surgeon to return to that operation, so a qualified practi- tioner performs noncritical components of the first opera- tion while a second procedure is initiated elsewhere. The second scenario is when critical elements of the first operation are done and the primary attending surgeon is performing key or critical portions of a second operation in another room. In this case, the primary attending surgeon must have another attending physician with immediate availability assigned to the first operating room. "The patient needs to be informed in either of these cir- cumstances," according to the standards. "The performance of overlapping procedures should not negatively impact the seamless and timely flow of either procedure." L.D. Britt, MD, DSc, a past president of the ACS and current chairman of the Eastern Virginia Medical School department of surgery in Norfolk, told The Boston Globe the guidelines should serve as a wake-up call for surgeons who have ignored rules prohibiting overlapping critical parts of surgeries. "The patient needs to know what's going on. It's their body being operated on," Dr. Britt told reporters. "They should know when you're not going to be the surgeon. That's part of the contract." The issue of concurrent surgeries made national head- lines last fall, due to a report from The Globe's Spotlight Team that examined the practice at Boston-based Mas- sachusetts General Hospital. The report spurred several investigations and led to the termination and resignation of several top physicians. An MGH spokeswoman addressed the new ACS guidelines in an email to The Globe, saying "They are similar to the policy we adopted in 2012. We will carefully review our pol- icy in light of these guidelines and consider clarifications or modifications as seem appropriate." Still, the practice of overlapping surgeries draws criticism from people who say it is dangerous and unethical. Some critics even say the ACS standards will do little, if anything, to curb the progress. n

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