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Document: Perioperative Policy for Concurrent Surgical Staffing of Two Rooms
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Perioperative Policy for Concurrent Surgical Staf?ng of Two Rooms

1. POLICY



 

1.2. All activities related to concurrent staffing of two operating rooms will be
compliant with all legal and regulatory requirements including existing Centers

for Medicare and Medicaid Services rules for overlapping surgical cases.

2. DEFINITIONS

2.1. Concurrent staffing?Attending surgeons perform the operative procedures with
a team that consists of residents, fellows, and other clinical providers. The
attending is responsible for the oversight of the team and the care provided.
There are times when an attending surgeon will oversee the care provided by
teams in two operating rooms simultaneously, defined as concurrent staffing.
The attending will practice within the elements of this policy when concurrent

staffing occurs.

2.2. Immediate availability of a surgeon is met when the surgeon remains within the
main campus of the Massachusetts General Hospital and is able to return to the
operating room in a timely manner whenever he/she is responsible for surgical

care of a patient in the operating room. For the purposes of this policy, the
offices at Charles River Plaza, the Massachusetts and Ear Infirmary and the

Shriners Burn Institute are considered part of the MGH main campus.

3. PROCEDURES

3.1 Every patient in the operating room (OR) will have at least one attending
surgeon clearly designated in the patient's medical record.

3.2 The attending surgeon will inform the operating room team during the

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Developed:
Approved:

 

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preoperative huddle, either in person or by telephone, as to the surgical plan and
his/her availability or the availability for another attending surgeon for the entirety

of the case. This may include fellows as per Partners Policy on Supervision of
Residents and Clinical Fellows.

 

The attending surgeon will actively participate in the performance of each case.
This will require the attending surgeon to ?scrub? parts of each case, with well

defined exceptions, such as endoscopic procedures.

When a surgeon is scheduled in concurrent rooms, he or she must be in the OR
suite and not in clinic or their office.

In cases in which the primary surgeon is participating in a second case or is not
readily available, another attending surgeon must be designated as being
immediately available.

It is recognized that there may be extenuating circumstances, such as
simultaneous emergency cases when on call, in which a surgeon may make an
exception to having a second designated surgeon available.



 

The allocation of simultaneous elective blocks for surgical case scheduling
purposes will be at the discretion of Division/Department Surgical Chiefs with
consideration of all billing compliance regulations, quality and efficiency of OR
performance, experience of training in staffing two simultaneous operating
rooms of the individual surgeon, and appropriate assistant availability.

Each department will review quarterly the performance of surgeons as to their
adherence to these guidelines in consultation with the perioperative leadership.

Service leadership will be instructed to establish a definition of the ?critical
components? of most standard operative procedures on their service, as well as
defining Operations and patient conditions when overlap of operative procedures
is not appropriate. These de?nitions should be maintained by the service chief
and monitored by the department in consultation with perioperative leadership.
In the absence of specifically defined critical components of a surgical procedure
by Service leadership, the critical components will be determined by the

attending surgeon.

Three simultaneous cases as the primary surgeon are not allowed under any
circumstances.

Department of Surgery (2012)
Surgical Coordinating

Committee

Clinical Policy and Record 9/28/2012
Committee

Medical Policy Committee 10/29/2012

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