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American College of Surgeons Releases Guidelines on Double-Booking Surgeries

ACS says "overlapping operations" are OK, but patients should be informed.

Published: April 15, 2016

STRONG STATEMENT? New ACS guidelines requiring patients to be informed about "overlapping operations" will be a wakeup call for surgeons, says L.D. Britt, MD, MPH, FACS, FCCM, who helped write them.

In its new guidelines on double-booking surgeries, the American College of Surgeons calls for surgeons to always inform patients when they plan to perform "overlapping operations" on different patients. Depending on whose view you embrace, the guidelines are either a wakeup call that will get reckless surgeons in line, or a timid directive that will do little to curb the practice of concurrent surgery.

The guidelines, issued this week, distinguish between scenarios that the ACS considers appropriate and inappropriate. "Overlapping operations," in which key or critical elements of one operation are complete, and a second operation is started "while a qualified practitioner performs non-critical components of the first operation," such as wound closure, are acceptable. "Concurrent or simultaneous operations," during which the same primary surgeon is responsible for "critical or key components" of 2 or more procedures at the same time, are not.

In the case of overlapping operations, "the patient needs to be informed," say the new guidelines, which are not legally binding, but are presumed to be influential. Such procedures "should not negatively impact the seamless and timely flow of either procedure," the ACS adds.

Experts offer dramatically different interpretations to the Boston Globe, which helped draw attention to the issue in an expose earlier this year that focused on rampant "double-booking" at Massachusetts General Hospital.

"The patient needs to know what's going on," L.D. Britt, MD, MPH, FACS, FCCM, tells the Globe, characterizing the new guidance as "a wakeup call to surgeons," whose "feet will (now) be held to the fire." Dr. Britt, a former president of the ACS, served on the committee that drafted the new standards.

However, others note that the new guidelines are essentially a restatement of current Medicare billing rules. "These guidelines are inadequate," says James Rickert, MD, president of the Society for Patient Centered Orthopedics. "They simply codify and defend the status quo regarding concurrent surgery."

Dennis Burke, MD, a key figure in the Globe expose, is even harsher in his assessment, saying the new guidelines "do nothing to promote patient safety, but rather are a total capitulation to professional self-interest." Dr. Burke had his privileges revoked by Massachusetts General after he shared medical records from which identifying patient information had been redacted with the paper. He now operates at Beth Israel Deaconess Hospital in Milton, Mass.

Noting that guidelines leave it up to the primary surgeon to determine "the critical or key components of an operation," Senator Charles Grassley (R-Iowa), also expresses skepticism. "It's not clear how these guidelines would change the status quo. … The surgeons apparently would still define the critical part of surgery when they need to be in the room," says the chairman of the Senate Finance Committee, which oversees Medicare.

Jim Burger

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