It's common for both surgeons and anesthesiologists to supervise more than one case at a time, but the practices are suddenly under scrutiny.
When a surgeon operates on more than one patient at a time, switching between cases while residents and fellows handle the more routine tasks, it's called simultaneous, concurrent or overlapping surgery. "Double-booking" lets a hospital's top surgeons do more procedures and gives its surgeons-in-waiting real-world experience.
When anesthesiologists oversee 2, 3 or even 4 CRNAs at once, monitoring the course of anesthesia administration at frequent intervals, it's called medical supervision. Jay Horowitz, CRNA, and John Dombrowski, MD, debate medical supervision's place in medicine in a point-counterpoint on page 6.
Meanwhile, "double-booking" has come under national scrutiny after a Boston Globe exposé of problems related to overlapping cases at Massachusetts General Hospital (see "Has Double-Booking Surgery Gone Too Far?"). The U.S. Senate Finance Committee is looking to explicitly ban surgeons from dividing their attention between patients.
The alleged problems are ghastly: surgeons failing to respond to emergency situations, not showing up at all or leaving anesthetized patients waiting. The practice has led to several malpractice suits involving Mass General. The Boston Globe reported that little scientific research has been done on concurrent surgeries, and that "there is no consensus among top doctors about which procedures can safely overlap, and how much overlap is appropriate."
The American College of Surgeons released new guidelines indicating that providers should inform patients in advance if their surgeons are scheduled to perform overlapping surgeries.
This is a complicated issue involving patient safety and consent, but it's an interesting exercise to compare both situations. An observer could fairly assume that it's apparently safe for anesthesiologists to bounce from room to room while cases are going on — and to be paid to do so — but not for an attending surgeon to oversee multiple surgeries in multiple ORs at the same time for at least a portion of the procedures. Does this mean that patients are safer under the care of a nurse anesthetist than they are a resident or fellow?
Anesthesia calls its MD-CRNA care model "team-based anesthesia" and "anesthesia care team." Medical supervision is far from perfect, especially from an economic standpoint, but it appears to be the perfect solution for what matters most: the safety of the patient on the table.
Speaking of double-booking, our staff photographer, Pamela Bevelhymer, RN, BSN, pulled off quite a feat this month. Not only did she take the photographs for this issue's cover, but that's her in (both of) them. She placed a stuff animal in the chair as her sit-in, set the timer on the camera and then pressed down the shutter to focus. She then ran to the chair, removed the stuffed animal, sat and posed.
"It took me about 7 times to get it right," she says.
Enjoy the issue. From all of us here at Outpatient Surgery Magazine, wishing you and yours a happy, healthy 2017. OSM