Overlapping Surgeries Push Massachusetts Board to Alter Rules

Marcia Frellick

January 15, 2016

In the wake of recent reports published in the Boston Globe that questioned the practice of double-booking surgeries, the Massachusetts Board of Registration in Medicine has voted to require surgeons to document each time they enter or leave an operating room, the paper reports.

According to the report, it is apparently the first such move by a medical board nationally.

The board also voted on January 7, among a series of other resolutions and regulation changes, to require that the primary surgeon name who the replacement would be if he or she left the operating room.

A spokeswoman for the board declined to comment to Medscape Medical News, beyond saying that the "proposed changes still need to be reviewed internally with the commissioner of the [Department of Public Health] and others." A public comment period will follow, and any changes would be submitted to the board for another vote.

Double-booked or overlapping surgeries have raised patient-consent issues, at least in Massachusetts. While some say it is an efficient way to complete more surgeries and primary surgeons don't necessarily have to be present for every step, others say the practice could violate patient trust.

As referenced in Medscape Medical News, the Globe reported in October that patients at Massachusetts General Hospital (MGH) routinely were granting informed consent without knowing that their attending surgeon would be in charge of two overlapping operations or that surgical residents and fellows sometimes performed entire operations while the attending surgeon was elsewhere.

The paper also noted it found that nurses were required to sign in and out of operating rooms, but surgeons were not.

The Globe said it surveyed 47 hospitals nationwide and found it "is common for surgeons to start a second operation before the first is complete, often after the surgeries were deliberately scheduled to overlap briefly."

Rare Occurrence at OSU Wexner

However, Steven Steinberg, MD, chief of trauma and critical care at The Ohio State University Wexner Medical Center in Columbus, said there are clear rules around overlapping surgeries at Wexner. "I am virtually never involved in doing two cases at once," he told Medscape Medical News.

"We have a fairly detailed compliance policy," Dr Steinberg said, "that meets the [Centers for Medicare & Medicaid] requirements to assure that the surgeon is present during, at the minimum, the critical portion, and that if they are covering two cases, the critical portions of the cases can't overlap." He said they also have a requirement that another surgeon must be identified as immediately available if the primary surgeon is out of the room.

Dr Steinberg said signing in and out of the operating room "sounds onerous for surgeons or staff," but said if Massachusetts' board is setting such rules, he would expect some other boards to follow. "I suspect we'll be talking about it in Ohio at some point," he said.

He said he doubts double-booking is a common practice nationally.

In response to the Globe articles, MGH published a memo on its website that included this perspective: "At MGH, any type of overlap occurs in 15 percent of surgical cases, but in only a minority of these (3 percent) is there overlap of the surgery itself."

David Hoyt, MD, executive director of the American College of Surgeons (ACS), also said in a previous interview with Medscape Medical News, "I don't think the problems are widespread at all, but we have no way of knowing." However, he said the ACS will discuss whether the society's guidance on concurrent surgeries needs to be more precise.

Dr Steinberg has disclosed no relevant financial relationships.


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