Overlapping Surgeries: 3 Patient Safety Actions Nurses Can Take

The term “overlapping surgery” has been receiving more attention in the media these days, although the practice is not new and not uncommon, according to Pat Turner, RN, BSN, MPA, a perioperative nurse consultant and longtime OR director.

Tight surgical schedules and high efficiency turnovers are a well-known reality in today’s OR. However, overlapping surgery is a trend toward high perioperative productivity that is not as widely discussed beyond the OR, yet it happens more than you might think, Turner cautions.

“The risk is that the second patient is under anesthesia and a complication arises in the first surgery that delays the surgeon,” she says, noting that patients left under anesthesia for long periods of time without a surgeon available to start the second procedure occurs often enough to cause concern. In addition, adverse events have been documented in patients undergoing a surgery in which the attending surgeon has left the OR and started a second operation.

Understanding the Difference Between Overlapping versus Concurrent Surgery

The American College of Surgeons (ACS) defines concurrent (simultaneous) and overlapping (sequenced) surgeries like this:

Concurrent or simultaneous surgery— Operations that occur “when the critical or key components of the procedures for which the primary attending surgeon is responsible are occurring all or in part at the same time.” The ACS says it is inappropriate for a primary attending surgeon to be involved in concurrent or simultaneous surgeries on two different patients in two different rooms.

Overlapping (sequenced) surgery—An operation during which the primary surgeon is “initiating and participating in another operation when he or she has completed the critical portions of the first procedure and is no longer an essential participant in the final phase of the first operation.” By definition, key moments of each procedure are occurring at different times.

Putting the Patient First

Turner believes nurses play an important role in managing cases that run back to back or overlap. She suggests all perioperative nurses be aware of these three actions they can take to proactively ensure patient safety when such scenarios occur in their OR:

1. Plan Ahead for room set-up duration—Nurses play an important role in coordinating timing for room set-up depending on the procedure, Turner says. For example, a robotic case can take additional time to set up. “Nurses have control over the second room when someone goes in and starts to prep and drape, be mindful not to start the second room too early.”
2. Coordinate timing with surgeons—Pre-planning for surgeries, such as during the preoperative huddle can be very beneficial in understanding patient nuances and surgeon scheduling that may impact the sequence and timing of surgical patients. “Talk to surgeons and be aware of the schedule and any planned concurrence or overlap in scheduling to be ready for your patient’s safety,” Turner stresses. “Also be in communication with surgeons during the case to plan ahead for any unexpected delays with the first patient that could impact timing for preparing the second patient for surgery.”
3. Raise concerns up the chain of command—"Nurses working on the frontline in the OR have an important vantage point to understand how cases are being handled and any concerns they have about overlapping or concurrent surgeries should be voiced,” Turner stresses. She hears this occurrence happening more and more beyond the academic setting where surgical residents may not be there to step in. “Advocate for your patients first and raise the red flag if you are concerned.”

Turner also cautions that accreditation and regulatory bodies are taking a closer look at practices related to overlapping surgeries and more stringent requirements for when the surgeon is in the room may be more strictly enforced in the near future.

Review the American College of Surgeons Statements on Principles related to concurrent and overlapping surgeries and read this article by Hoyt 2017 on overlapping surgery safety data and ongoing concerns.

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