Most hospitals allow salespeople in the OR
Although you hope they aren’t poking around in the patient, salespeople are a common sight in almost any hospital’s operating rooms. That is the conclusion of a recent report from ECRI, the independent health care research organization in Plymouth Meeting, PA. Researchers there recently conducted a survey of 180 hospitals and found it is common to find salespeople and other types of visitors in hospital operating rooms. A firm 95% reported they allow salespeople and others to be present during surgery.1
Ostensibly, the salespeople are there only to give pointers on how to use a surgical item and to schmooze with decision makers who are trying out the new items. But sources tell Healthcare Risk Management it is not exactly a rarity for a salesperson to step over that line and actually use the instrument on the patient, especially during high-tech procedures in which the salesperson might be much more familiar with the device than the surgeon.
A New York case in 1979 is one of the few instances in which such an incident was documented. The patient did not die, but a malpractice case resulted in a $1 million settlement. (See HRM, February 1980, p. 157.) The case involved a total hip arthroplasty. The patient claimed the two orthopedic surgeons allowed a salesman to perform most of the procedure, making the existing hip problem worse. The surgeons said the salesman did not participate, and the case was settled without establishing the facts. The hospital agreed to pay $275,000, and the surgeons paid the remaining $725,000.
Tips for developing OR policy
Although nearly all of the hospitals surveyed by ECRI allow salespeople in the OR, there were many different policies regarding their presence, and some facilities had no policy specifically addressing them. ECRI advises having a policy that outlines exactly what is and is not acceptable. The group makes these suggestions:
• Obtain a legal release and require prior approval. The company represented by the visitor should provide a document releasing the hospital from any liability related to the sales repre - sentative’s presence. Any visitors, including sales representatives, should be required to make appointments to visit the OR. Even with an invitation from the surgeon, the visitor should notify the OR manager and obtain permission.
• Make sure the visitor knows proper OR conduct. Any non-OR personnel must be educated, either with written materials or an informal verbal discussion, on topics such as OR apparel, traffic patterns, avoiding the sterile field, universal precautions, fire safety, electrical safety, and radiation safety. The education does not have to be repeated for each procedure if the visitor has been in the OR before, but ECRI advises at least an informal reminder if this is his or her first time in your facility’s OR.
Document any noncompliance with proper OR conduct, including accidental violations. Report the incidents to the OR manager, who should have the authority to ban the visitor from the OR for causing serious disruptions.
• Do not take any guff from the salesperson. The salesperson or other visitor is always a guest in your OR and should act accordingly. If you determine that the OR is too crowded to allow the visitor even though there was prior approval, for instance, your determination is final. Do not let the salesperson argue about it.
The visitor also must comply with any instructions in the OR, and if the visitor interferes with the procedure in any way or upsets any member of the OR team, he or she should be told to leave immediately.
• Prohibit wandering. If the visitor is allowed to observe surgery, he or she should be escorted to and from the OR area. Clearance to observe the surgery should not be construed as clearance to wander the OR area and chat with anyone in sight. The visitor should not be allowed in the doctors’ lounges unless invited there by a doctor.
1. ECRI. Managing the risk of sales representatives in the operating room: an HRC survey. The Risk Management Reporter 1996; 15:1-7.
2. Salesman-surgeon case settled for $1 million. Hospital Risk Management 1980; 2:157.