15 Essential Risk Management Strategies for General Surgeons
Laura M. Cascella, MA, CPHRM
General surgeons face various risks in day-to-day practice. Adverse outcomes related to surgical treatment, diagnosis, and medical treatment can result from numerous factors, including issues with technical competency, clinical judgment, communication, documentation, and more.
Not surprisingly, MedPro Group claims data show that more than 70 percent of general surgery cases are related to surgical treatment. These cases also account for slightly more than 70 percent of total dollars paid for expense and indemnity costs.1
Within these surgical treatment allegations, the top issue cited is improper performance of surgery. This allegation accounts for 40 percent of general surgery malpractice cases. The most common procedure noted in these cases is cholecystectomy; other procedures noted include hernia repair, resection/colectomy, and appendectomy.
Improper management of surgical patients accounts for 29 percent of general surgery malpractice cases and involves various suboptimal situations during the perioperative period. These cases often are related to the surgeon’s response to developing complications.
A small percentage of surgical treatment allegations (4 percent) involve retained surgical items (RSIs). Although the case volume is low, these allegations are still concerning because RSIs are considered a “never event.”
The following list offers 15 essential strategies to help general surgeons enhance patient safety and mitigate the risks inherent in surgical treatment:
- Participate in ongoing performance improvement opportunities to enhance technical surgical skills and to ensure competency with procedures and technology. Examples of performance improvement activities include mentoring, continuing education, and ongoing practice performance evaluation.
- Use evidence-based guidelines and clinical pathways to standardize processes, improve efficiency, and support quality care.
- Consider using decision support systems, consultations, and group decision-making to support clinical reasoning and avoid errors in clinical judgment.
- Implement protocols for team-based communication, including protocols for care transitions, telephone triage, and communication with radiology providers regarding incidental findings on diagnostic studies.
- Communicate adequate, clear, and appropriate information to patients. Conduct thorough informed consent discussions, provide patient education, and encourage patients to be active participants in their care.
- Use a technique — such as teach-back — to gauge patient understanding, reduce the risk of miscommunication, and support patient adherence to care plans.
- Perform complete patient assessments and ensure timely ordering of tests and consults to prevent problems associated with ruling out or documenting abnormal findings.
- Review patient selection criteria for each procedure, reconcile patient medications, and ensure that all appropriate health information is available in patients’ health records.
- Verify that all necessary equipment and supplies are available prior to the start of each procedure.
- Participate in surgical team timeouts prior to commencement of surgical procedures. Encourage “speaking up” behaviors to address potential safety issues.
- Use safety precautions throughout each procedure, such as proper patient positioning, infection control best practices, and surgical item counts.
- Following surgical procedures, hold team debriefing/huddle sessions to identify opportunities for improvement.
- Document a complete, concise, and accurate operative report the same day as each procedure.
- Maintain a consistent assessment process following procedures, and evaluate patients against established discharge criteria prior to releasing them.
- Document all instances of patient nonadherence as they occur using objective information, and document any follow-up outreach or education provided to the patient or caregiver to address nonadherence.
To learn more about surgical risks and strategies to prevent them, see the following MedPro resources:
- Bariatric Surgery Malpractice Allegations: What Claims Data Show, and Ways to Reduce Risk
- Checklist: Preventing Surgical Site Infections
- Checklist: Preventing Wrong-Site Surgery
- Checklist: Risk Management Considerations in Surgical Practice
- Rise of the Machines: Robot-Assisted Surgery, Patient Safety, and Liability
- Risk Tips: Managing Operating Room Noise and Distractions
- Risk Tips: Reducing Risks Associated With Failure to Rescue
Endnote
1 MedPro Group. (2022). Claims data snapshot: General surgery. Retrieved from www.medpro.com/documents/10502/5086243/General+Surgery.pdf
