This is part of the “Ask ECRI” series of articles provided to Copic to share with our insureds; it focuses on questions ECRI receives from members regarding healthcare issues and concerns. ECRI is an independent, nonprofit organization improving the safety, quality, and cost effectiveness of care across all healthcare settings.
A member recently asked for policies regarding surgeons delegating noncritical elements of a surgical case to qualified practitioners while they begin surgery on a different patient in a different operating room.
The American College of Surgeons’ (ACS) Statement of Principles describes the intraoperative responsibility of the primary surgeon. According to ACS, a primary attending surgeon’s involvement in concurrent or simultaneous surgeries on two different patients in two different rooms is inappropriate.
However, ACS states that overlapping two distinct operations by the primary attending surgeon can occur under two general circumstances:
1) “…[W]hen the key or critical elements of the first operation have been completed, and there is no reasonable expectation that the primary attending surgeon will need to return to that operation. In this circumstance, a second operation is started in another operating room while a qualified practitioner performs noncritical components of the first operation—for example, wound closure—allowing the primary surgeon to initiate the second operation. In this situation, a qualified practitioner must be physically present in the operating room of the first operation.”
2) “…[W]hen the key or critical elements of the first operation have not been completed and the primary attending surgeon is performing key or critical portions of a second operation in another room. In this scenario, the primary attending surgeon must assign immediate availability in the first operating room to another attending surgeon.”
Under both of the above circumstances, ACS states that the patient must be informed, and that “the performance of overlapping procedures should not negatively affect the seamless and timely flow of either procedure.”
In addition to guidance from ACS, the following resources may be useful:
- Overlapping Elective Surgical Procedures (UCLA Health)
- Overlapping and Simultaneous Elective Surgeries (Washington Medical Commission)
- Policy Statement: Concurrent Surgery (American Society of Plastic Surgeons)
- Lessons Learned from Recent Concurrent Surgery Settlements (Dentons Health Law)
- The Effect of Overlapping Surgical Scheduling on Operating Theatre Productivity: A Narrative Review (Anaesthesia)
- A Survey of Overlapping Surgery Policies at U.S. Hospitals (Journal of Law, Medicine, and Ethics)
- CORR Synthesis: What Is the Current Understanding of Overlapping Surgery in Orthopaedics, Particularly as it Relates to Patient Outcomes and Perceptions? (Clinical Orthopaedics and Related Research
- AHA, HAP Amicus Brief on Concurrent and Overlapping Surgeries, November 1, 2021 (American Hospital Association)
The recommendations contained in Ask ECRI do not constitute legal advice. Facilities should consult legal counsel for specific guidance and develop clinical guidance in consultation with their clinical staff.
ECRI Published Date: September 16, 2025
The information provided herein does not, and is not intended to constitute legal, medical, or other professional advice; instead, this information is for general informational purposes only. The specifics of each state’s laws and the specifics of each circumstance may impact its accuracy and applicability, therefore, the information should not be relied upon for medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation.
Article originally published in Copic’s Copiscope 1Q26 newsletter.
