Surgical Tools to Include RFID

andrewman327 writes "Reuters is reporting that hospitals are considering embedding RFID tags in surgical tools to prevent leaving them in patients. After closing a patient, doctors would wave a receiver over the body to look for the chips which would indicate that something was left inside. The biggest current stumbling block is the chip's size, though scientists hope they will continue shrinking as the state of the art advances."

Comments

Or maybe?

[elzurawka]

they should use this
if size matter, u cant been the size of Tomato Seed. All the tools could be put down on a sensor pad, and it could tell if everything has been returned, or have a running list of what is not on the pad ATM.

Re:A better idea...

[955301]

You'd think; however, the doctor needs tools to close you back up. If one of these tools is lost during the process and after the check, we're back to the same problem.

Okay. But...

[Khaed]

Just count the damn instruments.

Really. Car mechanics count screws.

I count the screws when putting a computer together or doing work in it. I keep up with where each one goes.

It didn't take me over eight years of college to figure this kind of thing out.

"Okay, doctor, we used five clamps, but we only have four. We must have left one..."

Duh? I mean, hello? You're a doctor. You're getting paid more than ninety percent of the population.

Learn to count.

Re:Okay. But...

[elzurawka]

If your in a emergency room, you might have hundreds of tools that you need quick access to. You dont have time to count, or probobly the mental dextarity to remember to count, the number of tools your using when your trying to save someones life.
You need to concentrate on what your doing, not on how many clamps you've used.

Re:Okay. But...

[gstoddart]

Just count the damn instruments.

Really. Car mechanics count screws.

Well, I suspect in the case of surgeries, if something starts going wrong, they're probably more busy trying to keep you from dying than remembering if that was the 5th or 6th hemostat of the day.

When all goes perfectly normal, this might be easy. But when it starts going all to poo, I suspect that's a context in which careful counting can go by the wayside. Things probably get a little frantic when the patient is about to die.

(Admittedly, on a 'routine' procedure where everything goes as expected, I would think your solution would be effective and obvious. ;-)

Cheers

Re:Okay. But...

[lazlo]

a pile of bloody sponges is much harder to count

Maybe, but it's done. The last surgery I watched (my wife's C-section) they were extremely meticulous about sponges in versus sponges out. They double-checked the count of the number of packs-of-10 sponges in the room at the start, there was one person who it appeard had the sole duty of counting used sponges and putting them in little plastic strips with 10 sponge-sized pouches per strip. Then someone else double-checked that count. Then before they closed, they counted the number of unopened packs and added the number of plastic strips, and made sure it was the same as the number they started out with. It seemed like a very well-thought-out way of avoiding that exact problem.

Actually, as far as uses of RFID go, this seems like a fairly good one. The incremental cost of adding RFID to surgical instruments is trivial, you aren't working against a dedicated attacker trying to subvert your system, and although the number of instances of instruments left in patients is fairly low, this system, I would think, would probably cost-justify itself given the cost-per-incident-avoided.

Re:Okay. But...

[Shadowlore]

If your in a emergency room, you might have hundreds of tools that you need quick access to. You dont have time to count, or probobly the mental dextarity to remember to count, the number of tools your using when your trying to save someones life.
You need to concentrate on what your doing, not on how many clamps you've used.

That is why there are assistants! Seriously dude, you've got people, even in ER, who handle the tools and are not operating. Doctors don't just say "scalpel" and they magically appear in their hand. And they don't have to count either. A pair of trays. One with the tools laid out with a placement pattern below it, and the tools in their place, and an empty one next to it. When a tool is handed back you put it on the blank tray in it's place. No math involved, just your eyes. This type of procedure works well "on the battlefield", there is no reason not to work in a civilian ER.

Furthermore, it isn't that hard to look at the opening for shinys before closing it up. Between the assistants keeping track of tools and the doctor looking at his work to see if there are any tools left there, there should be no excuse for leaving things in. Period.

Common occurrence?

[LunaticTippy]

I'd say it's fairly common. Common enough that I personally know 3 people who've had things left inside them.

Expect it to become more and more common as surgeons become even more painfully overworked. It's not their fault. I blame a bizarre system of high spiralling costs combined with drastic costcutting.

This may be an effective solution for leaving surgical tools behind, but that is treating a symptom instead of the root cause. Which is typical of US healthcare.

Re:Common occurrence?

[Mr. Burrito]

There is actually a lot that goes into becoming a competent physician. You may want your doctor to remove a mole now, but if that was all your doctor could do you might feel shortchanged when you needed someone to be able to manage your barely compensated congestive heart failure, set up your mechanical ventilator when you develop ARDS after a devastating car accident, or coax your premature infant through the first months of life.

In some ways a physician is a "biological mechanic" (I suppose). But a physican in the US accepts at minimum 11 years of school and post-graduate medical training after high school (in my own experience, 16 years), and typically accrues between $150-400k in debt during this time. But more important than the enduring agony of never-ending school (much of which is also physically demanding), they also accept the emotional responsibility for others' lives.

This responsibilty is drilled into us from the time we enter medical school and continues throughout training. Medicine is a noble profession and it has to be, because there is a lot at stake. We enter into a legally binding contract with every patient we talk to, touch, or are curb-sided about by a colleague, to provide medical care that is "standard of care". This is a lot of responsibility and it is a heavy burden.

When patients die in our care, even if it is not "our fault", it is very difficult. Until you have had to personally sign the order: "1)comfort care only -- start morphine drip, 2) extubate" for a critically ill patient who has reached the point of medical futility despite your 2 weeks of effort, and then hold their hand as you let them die, you will not understand this kind of contract. But just about every physician has had to do this, probably within the first few months of internship.

With regard to residency being a hazing experience -- in some ways this is true. However, there are just a certain number of situations and disease states that you have to encounter in training and life is only so long. If you cut the hours in half, you really would need to be in residency twice as long to be competent on your own. Then I guess we would really be in a bind as far as physician supply. The AMA has a difficult job enough as it is, balancing physician supply with demand and making sure that training programs meet minimum standards to ensure adequate training.

The economics of health care are admittedly complex. However, the $40 you spend in Austria is in fact heavily subsidized by taxes. Somebody has to pay the transcripionist, the nurses, the medical assistants, the overhead associated with the clinic physical plant, among numerous other things. Then some portion maybe ought to go to the physician who is actually seeing the patient. In the US, somewhat less than 15% of health care costs represent physician reimbursement. Apply this to your $40 tab in Austria and use your analytical skills to show me how this makes financial sense.

Re:Common occurrence?

[Mr. Burrito]

Your equating the practice of medicine to installing upholstery and transmission repair is a little humorous. I guess you would want the upholsterer to know about transmission repair if they were connected by thick blood vessels that were bleeding like stink and the car was about to die. An upholsterer can go take a bathroom break and catch Oprah in the middle of a job. I really would have liked to do that on numerous occasions in the OR. You say that the critical stuff doesn't happen very much, but 50% of my medical school class specialized in fields other than primary care, and even some fraction of the primary care folks are hospitalists and they deal with very sick patients on a daily basis. I actually know very few people in my class who don't deal with very sick people on a daily basis. Besides that, knowing what is critical and what isn't isn't easy, and when doctors screw that up is when they make the evening news. But I will try to explain this difficult topic.

For starters, dermatologists are and really need to be experts of the skin system. The skin is actually a fantastically complex organ that is essential for survival. There are all kinds of primary skin disorders as well as all kinds of cutaneous manifestations of systemic diseases that dermatologists must recognize, understand, and know how to treat. So they need to know a lot about all these other systems and communicate effectively to the doctors that treat those systems, too. They perform a lot of surgery and prescribe a lot of medications, and they need to understand all sorts of medical issues that might be contraindications to surgery or medication, including congesive heart failure. They need to understand and be able to treat or at least provide initial treatment of a number of possible complications. They need to communicate effectively with the pathologist, with the internist (who may further coordinate care), or the general surgeon, who may be called upon to perform more extensive surgery. Dermatologists may be involved in continuing care of patients with quite complex medical histories. Dermatologists typically do a medicine internship before their residency training. This can be very demanding, but it is absolutely necessary.

But maybe you went to family practice doctor first. Believe it or not, a family doctor needs their medical school and residency to: 1) know that it probably is a mole and not a melanoma, 2) know what medications to use for local anesthesia, their contraindications, and how much to use, 3) what the best resection method is to preserve a good cosmetic outcome, 4) how to suture it up without it popping open and increasing the risk of infection or a bad cosmetic outcome, 5) how to package the skin sample so that the pathologist can examine it effectively, 6) read and understand the pathologist's report, and 7) know what to do next if the mole actually isn't a mole but a melanoma. These are just the basics, though, because there are whole books written about each step. After the mole is removed, you might want to talk to your FP about some palpitations you've been having, and he or she needs to know all about the heart -- what is worriesome, what is not, how to read an EKG, etc. Or you might want to ask about your back pain, and he or she needs to know what the worrisome signs are (because there are actually a lot of things that can cause back pain that you really need to rule out even though common things are common). The FP is also looking out for your best interests and keeping track of when you need a mammogram or a colonoscopy, and they need to know all about breast and colon cancer. The list of things they need to know is very long. What specifically would you have them not know about?

The AMA has a pretty powerful say, but a lot of physicians are not AMA members. The various medical colleges keep a very close eye on the minimum requirements for training for minimum competence in the various specialties. Medical school really is the minimum level of training for a doct

Turn it around

[Bruce Perens]

I'm more worried that they won't forget to put the RFID in the patient before they close the body.

Bruce

Re:How common is this problem...

[Anonymous Coward]

The most common foreign body left inside a body cavity is a sponge. They get tucked behind various organs/tissues to hold things in place, absorb blood/fluids, etc, and sometimes blend in with the surrounding tissues.

Counts *are* taken of equipment, sponges, etc, but... humans make mistakes. Considering the number of surgeries performed, it's actually pretty amazing how few items get left behind. The need for the technology, however, stems from how dire the consequences can be from a mistake.

If a mechanic leaves a washer inside an engine when reassembling it, it might do some damage, but most likely no one will die.

Re:Pencil and Paper ... easier & cheaper

[Dun Malg]

WTF? Why do they need a superduperwonderfulelectrogadget to solve this problem? The easier & cheaper solution involves a pencil and a piece of paper. Do you have the scalpel? Check. Do you have the bar of soap? Check.

Cripes, is this really that hard to understand? Currently, the way they do it is have people counting the instruments, through all sorts of redundant methods. Still, because it's humans doing the work, the system is subject to occasional human error. Your solution of "pencil & paper, duh" is more if the same: it's humans doing the work, so the system is subject to human error. RFID takes the error inducing element out. Pencil and paper does not.