MedPro Group claims data show that allegations related to surgical treatment represent the highest malpractice case volume for gynecology providers. These allegations also account for more than half of all dollars paid for expense and indemnity costs associated with gynecology claims.¹

Within these surgical treatment allegations, the top issue cited is improper performance of surgery. This allegation accounts for 42 percent of gynecology malpractice cases — more than half which involve hysterectomies. Other procedures noted in these allegations include oophorectomy, laparoscopy, and incontinence-related procedures.

Improper management of surgical patients accounts for 15 percent of gynecology malpractice cases and involves various suboptimal situations during the perioperative period, such as inadequate monitoring of vital signs, improper surgical skin site preparation, and delayed recognition of complications following discharge.

A small percentage of surgical treatment allegations (5 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 strategies to help healthcare organizations and gynecology providers manage the risks inherent in surgical treatment:

1. Adhere to well-defined credentialing, recredentialing, and privileging policies, including evaluation of surgical skills and competency with surgical equipment through ongoing practice performance evaluation and focused professional practice evaluation.
2. Implement peer review processes and conduct peer review activities to improve performance and quality. Routinely evaluate quality indicators and implement performance improvement plans to address safety risks and improve quality of care.
3. Engage in ongoing continuing medical education and training opportunities to enhance technical surgical skills and communication skills.
4. Conduct thorough informed consent discussions with patients, including a review of risks, benefits, and alternative treatments. Speak in layman’s terms during these discussions, and use a technique such as teach-back to gauge patients’ comprehension of information.
5. Document informed consent discussions, including the provision of verbal and written patient education; make sure any signed informed consent forms are included in patients’ records.
6. Verify that each patient’s record contains thorough and appropriate information, such as history and physical, current medications, nonpharmacological interventions, allergies, pain assessment outcomes, test results, consults/referrals, treatment goals, and preoperative screening results.
7. Conduct a thorough preoperative screening of each patient for risk factors, and ensure that all appropriate health information for the patient is available prior to commencement of a procedure.
8. Inventory and verify necessary equipment and supplies before each procedure begins.
9. Ensure infection prevention and control best practices are used to maintain the sterile field (e.g., best practices related to hand hygiene, safe injections, skin preparation, instrument sterilization, environmental cleaning, etc.).
10. Use standardized patient safety precautions during each procedure, such as timeout protocols, proper patient positioning, surgical item counts, etc.
11. Make sure patients are appropriately monitored during and following procedures (e.g., vital signs, airway, and pain).
12. Maintain a consistent postoperative discharge assessment process, and carefully consider repeated patient complaints or concerns when making clinical decisions about patient care and diagnostic testing.
13. Provide patients and caregivers with clear and concise written and verbal instructions related to their treatment plans and follow-up care.
14. Complete a detailed operative report on the day of each procedure.
15. 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.