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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."
I have a better idea.
Before 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 timing would be a little better, don't you think?
What happens if they forget the reciever inside the person?
Doctor: Nurse, hand me the wand.
Nurse: Don't know where it is.
Doctor: Oh well, I'm sure I didn't leave anything inside.
What if the hospital forgets to put the RFID chip in the instrument in the first place. It all comes down to accountability. Just count the damn tools before and after surgery. Seems simple to me. If there was a pliers before you started, then there should probably be one after you're done.
http://religiousfreaks.com/My dog has a very small RFID that I had the Vet intentional leave in him (name, address & phone number)... now my dog is suing me for violating his rights for privacy.
that we have to have use technology to prevent this from happening?
Why would surgeons (or assistants) think it's okay to leave a foreign object lying on top of an organ or tissue in the first place?! Also why is the surgeon in such a rush that s/he would be so sloppy?
Maybe this would be more appropiate for battlefield sitautions where things can get hairy, but then again, it's pretty rare to do open surgery in the battlefield!
Anyway put the patient on a non-metallic table and run a metal detector over them.
Doctor: "Where's the table?"
Nurse: "It was right here under the patient, who seems to be lying on the floor... "
Doctor: "Oh... Where shall we have lunch?"
How rugged are RFID chips? How are they going to hold up to being heated in an autoclave for sterilization?
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.
...I keep getting an unexplained $248.99 charge at the Target express line!
He who knows best knows how little he knows. - Thomas Jefferson
Warwalking. "Hm... Spidey-sense tingling. w00t! Free wireless!"
A computer technician. I know, I know, they are very much different...but they're actually the same, too. ;)
.... *SLAP*
Tech 1: Ok, just got done replacing the power supply in this bad boy, let's fire it up.
Tech 2: Hey, where's my screwdriver....
*ZOT*
Tech 1: Oh, wait a minute.... oh, ok here's the problem, I left this screwdriver lying on the motherboard and it fried the motherboard!
Tech 2: Shouldn't you have looked inside the case before you put the cover back on?
Tech 1: Maybe we should put RFID tags on our tools so I won't do this again...
Tech 2:
How about, stop smoking the sticky-icky right before you work on very important things (I.E. computers, human bodies)...
It is pitch black. You are likely to be eaten by a grue.
If a job's not worth doing, it's not worth doing right.
If a job's not worth doing, it's not worth doing right.
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.
Hey
Let me give you a quick summary of procedure in an operating room, as regards instruments and instrument counts:
Every surgeon has a card (usually, literally a 3"x5" index card) with preferences and requirements for each particular operation they perform: for an appendectomy they may need a Saxony brand defrobulator and a #10 blade as the specialized items and they like to close the bowel with 2-0 (aka 00) chromic (made from catgut) and they like to close the skin with 3-0 poly and 6-0 purebread (usually used in cataract / ophthalmic procedures, but hey Underdog spoke out to me.) There might be three each of any particular scalpel blade they need and howsoever much of those stitches threaded on the appropriate types of needles: curved, straight, cutting, non-cutting, etc. There will also be the appropriate number of hemostats, deblooduclips, etc, that are necessary for the procedure. For a different procedure, say a vasectomy,... okay, let's say cranial burr hole or craniotomy for decompression of subdural for all the guys wincing out there, they may want a hand-twist drill, plastic clips for holding the scalp edges, good thick chromic for the fascial closure, etc., so a different set of objects.
There will be a minimum of two nurses assisting with the procedure, a scrub nurse (scrubbed in to the operation, hence the name) and a circulating nurse. The circulator will make sure that the tray with all of the equipment is already there before the operation starts. Even before the surgeon scrubs in, the scrub nurse will also go over the instruments and objects and de a pre-op count: making sure that there is enough of every item and making a note of the number of objects, including sponges which are actually small pieces of cloth uses to sponge up that red stuff that leaks out humans when they're cut. These cloths usually have a radio-opaque fiber sewn into them so that when they're accidentally left in the human body, something is easily apparent on X-ray or C-T; cotton is not so opaque to x-radiation.
The nurses know that there are int counts[i] of char* objects[i] for each of the different objects. The preop counts array is usually written on the form the circ nurse fills out. Then all of the really good fun stuff
happens, and as it is almost all done and the surgeon is getting ready to close, the scrub nurse starts a pre-close count: counts that the number of needles handed back by the surgeon plus the number of unused needles adds up to the number that was in the pre-op count (for each variety of pre-threaded needle). They also check that the number of clean unused sponges (whether 1"x1", 2"x2", 0.5"x0.5", etc) added to the number of blooded sponges handed back by the surgeon off of the surgical field also add up to the number expected. All of the other instruments: retractors, hemostats, bolt-cutters (used to cut the titanium bars in the fun ortho cases), machetes (used in amputations...), are also counted to make sure none are missing. (sometimes, even retractors fall into the morbidly obese and are missed.)
If the pre-op count is not correct, there is a frenzy as the doc looks inside the patient (or, if the closing is happening real fast, the doc says find it find it and the nurses run around checking the little bits on the floor and mopping up with surgical cloths to see if a needle fell onto the floor or onto the surgeons' or nurses' gowns or even if the needle is stuck onto the bottom of the little blue booties the OR personnel are using to cover their hospital footwear.)
If the count is correct, then the closing is done, and then the scrub nurse does ANOTHER final post-op count and rewrites it all down to make sure nothing was left behind.
Amazingly, even in cases where stuff was left behind, the written records usually show that the count was correct: someone takes a shortcut and writes a copy of the list and it often isn't until the patient has an infection or a recurrent problems days, weeks, months, years down the r