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HRMR Annual 2016-17

Sedgwick CONCURRENT (OVERLAPPING) SURGERY: ADDRESSING THE RISKS Hospitals are re-examining their surgical and risk management policies in relation to overlapping surgery, as Kathleen Shostek, vice president of healthcare risk management at Sedgwick, describes. 20 | HEALTHCARE RISK MANAGEMENT REVIEW | Annual 2016 Professional and public outcries prompted the American College of Surgeons (ACS) to address the practice by revising its Statements on Principles to speak to concurrent surgery. With patient safety as a primary consideration, and the desire to avoid claims and lawsuits possibly related to concurrent surgery, hospitals are re-examining their surgical policies and practices. There are a number of ethical, risk management and patient safety issues surrounding concurrent surgery. Sedgwick risk management consultants have encountered many of these issues and concerns related to the practice while performing surgical risk assessments and making observations in the operating room. We have also received calls from our customers asking for information, resources and advice on the topic. Common issues and concerns include the following: • Longer anesthesia time for patients waiting for the attending ���������������������������������������������������������������������������������������������� • Lack of patient awareness (consent) regarding what portions of the surgery are performed by which surgeons or practitioners ���������������������������������������������������� • Inadequate supervision of surgical residents and scope of practice creep with surgical assistants when the primary surgeon leaves for �������������������������������������� • Operating Room (OR) nurses reporting fears of “patient ���������������������������������������������������������������������� • ���������������������������������������������������������������������������������������������������������� �������������������� debriefs. Read on for an overview of the risk management implications including regulatory compliance, professional practice guidance and surgical department policy considerations. REGULATIONS AND COMPLIANCE The Centers for Medicare and Medicaid Services (CMS) permits providers to bill the Medicare program for up to two simultaneous or overlapping surgeries, but the regulations note that the surgeon must be available for “critical” portions of both operations. CMS does not ����������������������������������������������������������������������3 The Medicare rules do, however, include requirements for another surgeon to be immediately available when the attending surgeon leaves to begin a second procedure and the attending surgeon must document his or her presence for the surgery. According to a December 2015 Boston Globe report, a Wisconsin medical school paid $840,000 to settle a lawsuit alleging that neurosurgeons Concurrent or overlapping surgery has been described as when a surgeon begins a second operation, leaving the rest ���� ���������������������������������������������������������������������������������������������������������������������� complete.1 Concurrent surgery has long been a common practice in teaching hospitals, and is thought of as an acceptable way to optimize surgeons’ skills, reduce delays, and allow surgeons in training or assistants to complete routine procedures. However, the practice came under scrutiny recently when Boston Globe reporters published an investigative report on the topic, spurring state and federal investigations. The report detailed patient-related events and subsequent complaints and lawsuits, and described concerns raised by surgeons about the practice to hospital administration.2


HRMR Annual 2016-17
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