The article, in the Journal of the American Medical Association, gives a series of recommendations for how to improve transparency and accountability when doctors run multiple operating rooms at the same time.

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An opinion piece published Wednesday in the Journal of the American Medical Association calls for widespread reforms in how hospitals handle overlapping surgeries and for better research to determine how patients are impacted by the practice.

The article, co-written by one of the journal’s deputy editors and a leading researcher at Stanford, explores how the medical community can restore public trust in overlapping surgeries in the wake of articles published by The Seattle Times and The Boston Globe.

Overlapping surgery, in which doctors run multiple operating rooms at the same time and typically delegate portions of cases to trainees, is a common practice at some medical institutions, although it is practiced to varying degrees. The authors suggested recent research on the subject was inadequate. They noted that studies examined all overlapping cases — including cases that may have overlapped for mere seconds — instead of examining whether cases with longer overlaps affected patient health.

A recent Seattle Times story about Swedish Health’s neuroscience institute examined internal data to show how brain and spine surgeons regularly ran parallel operating rooms for hours at a time. The journal authors, Michelle M. Mello and Dr. Edward H. Livingston, called for “stronger, prospective observational studies and randomized studies.”


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Other research, meanwhile, has shown that patients were unfamiliar with the practice of overlapping surgeries, with more than two-thirds of respondents expressing opposition to the idea and 44 percent saying they would not have chosen their surgeon if they’d known about the practice. The authors of the JAMA article said patients should be fully informed well in advance of the operation and told who will be performing which parts of the operation. Hospitals in Seattle have been updating their consent forms to be more transparent about the practice.

Surgeons are generally required to be present for the “critical” portions of each surgery, but the critical portions are defined by the surgeons themselves. One doctor previously told The Times that there were no critical portions of some spine surgeries at Swedish — and that the attending physician would simply come in to approve that it was done correctly.

“Giving surgeons authority to unilaterally declare what the critical parts of an operation are does not work, as evidenced by the repeated episodes of billing fraud, retaliation against whistleblowers, and loss of public trust,” Mello and Livingston wrote. They believed that surgeons may have their judgment influenced by pressure to generate revenue.

The JAMA article calls for the critical portions of surgeries to be set by “a multidisciplinary committee within the hospital.” The article also says surgeons should clock in and out of the operating room so there is a record of when they were present. Staff members at Swedish have previously expressed concern that the hospital wasn’t tracking when surgeons were in the operating room.

The authors also wrote that hospitals should clearly define what it means for surgeons to be available if they are needed to rejoin a case when complications occur. They also said hospital policies should protect those who report concerns about violations.

“After staff are educated about the policy, adherence must be documented and actively monitored,” the authors wrote. “These steps can do much to ensure that abuses of overlapping scheduling do not further undermine public trust in the practice of surgery.”