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Surgeon sued for double booking surgery

There’s a reason why the American College of Surgeons (ACS) recommends asking patients if they’re okay with a concurrent surgery before operating. A Manhattan doctor found that out the hard way, after two former patients sued him last month for $14 million, according to the Boston Globe.

The patients claim that David B. Samadi, MD, chief of urology at Lenox Hill Hospital, allowed doctors-in-training to perform their prostate surgeries, and was only present for 25 minutes for one of the surgeries. Further, they claimed they were put kept under general anesthesia longer than necessary to hide Samadi’s absence, and that the operations were botched.

Last year, a review of more than 2,000 neurosurgical cases published in the Journal of the American Medical Association found no greater risk of postoperative complications for patients operated on by surgeons conducting overlapping surgeries. That said, the ACS guidelines are clear that patients need to know about and consent to an concurrent surgery before a provider does one.

Bradley T. Truax, MD, principal consultant of the Truax Group, says that patients should absolutely be informed if you plan to do their surgery concurrently.

“It is one thing for the surgeon to discuss with the patient that other personnel (residents, fellows, surgical assistants, etc.) will be participating in their surgery,” he says. “But the surgeon needs to make it clear what their roles will be and that the attending surgeon him/herself may not be present for the entire procedure.”

Study: ED intervention reduces suicide attempts by 30%

How much of a role can emergency departments (ED) play in preventing suicide attempts? The world’s largest study of 1,376 suicidal patients gave the answer.

By implementing interventions at the ED, hospitals were able to lower the of risk patients attempting suicide again by 20% compared to if they are treated as usual (TAU). Researchers also found that “there were no meaningful differences in risk reduction between the TAU and screening phases.”

The study, called the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE), was the largest suicide intervention trial to date, covering patients from eight EDs and seven states.

“Results indicated that the provision of universal screening, while successful in identifying more participants, did not significantly affect subsequent suicidal behavior compared with that experienced by participants in the TAU phase,” they wrote. “By contrast, those participants who received the intervention had lower rates of suicide attempts and behaviors and fewer total suicide attempts over a 52-week period.”

With around 42,000 deaths annually, suicide is the seventh leading cause of death for American men, the 14th for American women, and the 10th overall. Annually, there are 460,000 ED visits that occur following cases of self-harm and a single ED visit due to self-harm increases future suicide risk by almost sixfold, according to the study.

The study compared a control group of patients who were given TAU, a group that was just screened, and one group that was screened along with interventions.

Intervention efforts included additional suicide screening, suicide prevention info, and a personalized safety plan for dealing with future suicide ideation, and periodic telephone follow-ups. Those who got these interventions made 30% fewer total suicide attempt than others.

“We were happy that we were able to find these results,” said lead author Ivan Miller, PhD, professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, in a statement. “We would like to have had an even stronger effect, but the fact that we were able to impact attempts with this population and with a relatively limited intervention is encouraging.”

Overall, 21% of those studied made at least one suicide attempt within 12 months. Those in the TAU group had a 22.9% suicide attempt rate, while in the screening group it was 21.5%. The intervention group only had a rate of 18.3%. Of all patients studied, there were five fatal suicide attempts.

Communicating patient rights with physcians and staff

You can have the best policies and procedures in the world, but if communication and understanding by those who need to know is not available, the intent of the patient rights chapter will never come to fruition. The chapter captain assigned to patients’ rights, with guidance from the accreditation director, should develop a communication plan to ensure that everyone in the organization understands his or her roles and the impact the chapter holds in relation to job responsibilities and functions.

The first step in a communication plan is to include aspects of this chapter in the job application form and credentials application. Those applying for jobs and physician privileges need not apply if they are not willing to adhere to and respect patients’ rights. For example, you could include the following language in your application:

By signing this application, I agree to treat patients and families with respect, ensure the patient’s privacy and confidentiality of health information, and to review the patient’s rights and responsibility notice.

Communication regarding patients’ rights should always be part of orientation to new board members, physicians, and staff. Some hospitals require all three groups to sign a document attesting that they will abide by and uphold these rights.

Ongoing communication is important for compliance with the patient rights chapter. In particular, the following topics should be considered for educational sessions or communication reminders:

  • Respecting cultural and personal values, beliefs, and preferences
  • Privacy and confidentiality
  • Understanding how patients understand (i.e., health literacy)
  • Advance directives and end-of-life decisions
  • Informed consent
  • Research/clinical trials
  • Dealing with disruptive people (e.g., physicians, staff, patients, family members)
  • Identifying neglect, exploitation, and verbal, mental, physical, and sexual abuse
  • Resolving patient complaints

Note: This blog post is an excerpt from The Chapter Leader’s Guide to Patient Rights: Practical Insight on Joint Commission Standards by Jean Clark, RHIA, CSHA.