Responding to concerns about surgeons operating on more than one patient at a time, the American College of Surgeons (ACS) recently updated its Statements on Principles with a section that makes clear that surgeons should not conduct two procedures simultaneously.
“A primary attending surgeon’s involvement in concurrent or simultaneous surgeries on two different patients in two different rooms is not appropriate,” the guidelines say.
The guidance comes in a section on the “Intraoperative Responsibility of the Primary Surgeon,” which includes new language on concurrent, overlapping, and multidisciplinary operations. The ACS is unequivocal about a surgeon operating on two patients in two rooms and moving from one to the other as necessary: That situation should never happen. There are some situations, however, in which the ACS says it is acceptable for the surgeon to have two patients undergoing surgery at the same time.
“In general, the patient’s primary attending surgeon should be in the operating suite or be immediately available for the entire surgical procedure,” the statement says. “There are instances consistent with good patient care that are valid exceptions. However, when the primary attending surgeon is not present or immediately available, another attending surgeon should be assigned as being immediately available.”
Some leeway is given for overlapping operations, such as when the key or critical elements of the first operation have been completed and there is no reasonable expectation that there will be a need for the primary attending surgeon to return to that operation. In that situation, the ACS says that it is acceptable for the surgeon to hand off that patient to a qualified practitioner who performs non-critical components of the first operation, such as wound closure, while the surgeon goes to another room and begins surgery on a second patient.
The surgeon also can have a second patient’s surgery begun by another practitioner and step in to perform the critical elements after completing the first patient. In that situation, however, the ACS says that the surgeon must assign immediate availability in the first operating room to another attending surgeon because the surgeon may not be able to leave the second patient if trouble arises with the first.
The patient should be informed of the surgeon’s involvement in more than one procedure at a time, ACS says.
Consent questioned
Concurrent surgery became widely known to the general public when The Boston Globe published an expose about a malpractice suit filed by a plaintiff who was paralyzed during spinal surgery at Massachusetts General Hospital in Boston. He contends that his injury was due, in part, to the fact that his surgeon was splitting his time between that operating room and another where he was operating on a second patient at the same time. Massachusetts General has since limited surgeons from doublebooking some complex surgeries.
In addition to patient safety concerns, some critics said the patient should be informed of such practices. A hospital spokesman told the newspaper that surgeons are “encouraged and expected” to tell patients when they’ll be absent for part of the surgery, but not required. (The Boston Globe story is available online at http://tinyurl.com/zowtss6. For more on the controversy, readers can read “Concurrent surgeries: How much is too much?” Healthcare Risk Management, January 2016, available at http://bit.ly/1OYZXRm.)
The updated ACS guidelines are available online at http://bit.ly/1Mwqq8a.
