Risk Management Tools & Resources

 


Essential Risk Management Strategies for General Surgeons

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 malpractice claims data show that 77 percent of general surgery cases are related to surgical treatment. These cases also account for 80 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 51 percent of the surgical treatment cases. The most common procedure noted in these cases is cholecystectomy; other procedures noted include hernia repair, appendectomy, and colorectal resection.

Improper management of surgical patients accounts for 41 percent of the surgical treatment 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 essential strategies to help general surgeons enhance patient safety and mitigate the risks inherent in surgical treatment:

  • Participate in ongoing performance improvement opportunities to improve 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. Carefully consider repeated patient complaints or concerns when making clinical decisions about patient care and diagnostic testing.
  • Consider using decision support systems, consultations, and group decision-making to support clinical reasoning and avoid errors in clinical judgment.
  • Implement protocols to standardize and improve 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 about procedures, treatment plans, anticipated benefits, potential risks, and alternative options. Avoid complex terminology and medical jargon, and provide information and instructions in lay language.
  • Use interpreters and auxiliary aids to assist with patient communication and comprehension for patients who have limited English proficiency or communication disabilities.
  • Use a technique such as teach-back to gauge patient understanding, reduce the risk of miscommunication, and support patient adherence to care plans.
  • Adhere to a standardized informed consent process that includes common and significant risks that are relevant to the patient and the procedure. As part of this process, consider whether patients have realistic expectations of surgical/procedural outcomes.
  • Thoroughly document the informed consent process, including the provision of educational materials. Make sure that any signed informed consent forms are included in patients’ health records.
  • 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 (e.g., history and physical, current medications, nonpharmacological interventions, allergies, pain assessment outcomes, test results, consults/referrals, treatment goals, and preoperative screening results).
  • Verify that all necessary equipment and supplies are available prior to the start of each procedure.
  • Use standardized patient safety precautions during each procedure, such as timeout protocols, infection prevention best practices, proper patient positioning, and surgical item counts. Encourage “speaking up” behaviors to address potential safety issues.
  • Make sure the perioperative team is appropriately monitoring patients during and following procedures (e.g., vital signs, airway, pain, etc.).
  • Following surgical procedures, hold team debriefing sessions to identify opportunities for improvement.
  • Maintain a consistent postoperative discharge assessment process that includes evaluating patients against discharge criteria and providing patients/caregivers with both written and verbal discharge instructions related to follow-up care.
  • Document a complete, concise, and accurate operative report the same day as each procedure.
  • 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:

Endnote

1 MedPro Group. (2025). Claims data snapshot: General surgery. Retrieved from www.medpro.com/documents/10502/5086243/General+Surgery.pdf

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