Slashdot Mirror
Bar Codes Keep Surgical Objects Outside Patients
Reservoir Hill writes "Every year about 1,500 people in the US have surgical objects accidentally left inside them after surgery, according to medical studies. To prevent this potentially deadly problem, Loyola University Medical Center is utilizing a new technology that is helping its surgical teams keep track of all sponges used during a surgical procedure. Each sponge has a unique bar code affixed to it that is scanned by a high-tech device to obtain a count. Before a procedure begins, the identification number of the patient and the badge of the surgical team member maintaining the count are scanned into the counter. When a sponge is removed from a patient, it is scanned back into the system. A surgical procedure cannot end until all sponges are accounted for."
Reference counting. Insert obvious garbage collection joke here.
Tee hee.
There is another kind of evil which we must fear most, and that is the indifference of good men. -- Boondock Saints
I'm guessing the scanner they use is fairly sophisticated, because bar code scanners aren't all that high-tech anymore, are they?
LRN 2 SWM
Anything that helps doctors and nurses to do their job properly is fine by me. Barcoding the items is a damn fine idea. Just don't know how it hadn't been implemented sooner.
Somehow I can't totally believe that. True, it will obviously remind them and stop them from leaving them accidentally, but what if the doctor just leaves? Does it lock the door?
</sadattemptandhumor>
Seriously though, what if there's a fire or something and not all the sponges can be accounted for? What if a doctor accidentally walks out with one? I agree that this will be useful a lot of the time, but it looks to me like their plan may not be 100% effective, and I sure wouldn't want to be left in the hospital to die because one sponge fell under the bed.
I bet that the amount of sponges in any given area is fairly trivial compared to the life of the patient that is on the line.
We all make mistakes, but surgeons today should have enough skill to ensure that objects are not left in the body in the first place. It seems like another scenario where use of advanced technology replaces basic skills that a human should have in these situations.
I'd prefer a doctor operating one me to pay attention to the patient not pause to remember if this was the 16th sponge he took out or if the 16th was the one he took out 10 minutes ago.
So until you have a medical degree and the years of on the job experience that it takes to even set foot in a surgery, you don't get to call anyone an idiot that does.
Doing otherwise makes you look like a typical fat,lazy, IGNORANT armchair skeptic who can't even be bothered to use the slightest bit of brain power their pathetic brain is capable of mustering.
If you mod me down, I will become more powerful than you can imagine....
Hell, sometimes they just get the wrong patient/records (take your pick).
If they get the right paperwork - they can operate on the wrong side. My mother is a nurse (30+ years), and her advice is to make sure you permanent-marker the correct area before they get you ready for your surgery.
As for leaving stuff in your sewn up body ~ it happened to my grandmother 4 times.
I guess you have underachievers, alcoholics, and newbies in every profession.
Just -1, Troll talking to another.
they're too busy doing surgery to worry about counting the number of sponges. but really, think of the number of surgeries that are done every year vs how many actually have this sort of thing happen. surgeons could probably go through hundreds of surgeries without anything remaining in a patient that wasn't supposed to be there and there's always that one time... anything that reduces the probability of harm to those going through surgery is a good thing, it's not perfect but it's improving and that's always a good sign,
Sigs are too short to say anything truly profound so read the above post instead.
Well, I laughed at the bottom of the post where it said
(tagging beta)
Wouldn't RFID be more appropriate than bar codes in this situation?
Quid festinatio swallonis est aetherfuga inonusti?
Africus aut Europaeus?
http://www.forumpix.co.uk/i.php?I=1197185097
i thort this was a good idea, why mod it -1?
I work at a Level 1 trauma center and we do indeed use RFID sponges. Currently we are only using them on a trial basis for trauma surgeries, but I would guess that once the cost drops some, we will infact use them for all surgeries. The RFID wands cost about $50.($135 patient cost). Sponges are bad, but the body will encapsulate them after awhile....retractors on the other hand....I don't know how the hell you leave something 1 foot long and 1.5 inches wide in someone...that boggles the mind. As someone said earlier though, when you have multiple surgeons, multiple residents, multiple scrub techs and circulators, things will get missed. Ofcourse the worst thing is what people call it when something is left in a patient or something goes wrong, a "surgical misadventure" that is just wrong.
No. RFID chips can break . . . better to have something that you can't come to rely on being able to track remotely. More importantly, though, adding barcodes to sponges and assorted other inserted instruments is easy and inexpensive, adding rfid chips is not. Especially something like sponges and other things that should not have hard bits in, not to mention that it's a bit wasteful for single-use items that you may use a hundred or more of in a single surgery.
"There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." - Ed Howdershelt
in state hospitals. But not just with sponges. Also with forceps and other surgical instruments :-S
*sigh* I stand very quickly corrected:
http://slashdot.org/comments.pl?sid=383979&cid=21629409
(Post in thread just above)
Still, I like barcodes better because of the breakage possibility - scan barcodes going in == guaranteed count, don't use a failed scan. Scan barcodes coming out - if one fails, manually count, easy enough. RFID has the advantage of catching error where something got used without going through the counter, though . . . . mebbe a combo is a good idea. Although in that case you may have slightly higher compliance issues because of the greater ease of one system . . . I'm too pessimistic to design medical devices, apparently.
"There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." - Ed Howdershelt
An RFID solution for this problem already exists. Surgical equipment and gauze and sponges are manufactured with a tag inside, or sewn on. A wand shaped like a loop is waved over the patient before the surgeon closes to make sure all foreign material is removed.
Surely this would be one good use of RFID. Then you could scan the disposal, and scan the patient, and make sure everything was detected in one and nothing left in the other.
I'd hate to be the one trying to scan barcodes from blood-soaked sponges. Isn't some equipment too small to barcode?
RFID has already been suggested (here is the old Slashdot story) and sounds much more convenient to use.
Much better, RFID in this field exists for years. RFID companies have long seen this as one of their early markets.
Just an example: http://www.rfidjournal.com/article/articleview/3572/1/1/
But GIYF.
Alas doctors would rather a high tech approach rather than just a good old fashioned checklist of procedures
Why not use RFID ?
That way, one could even find out the details of the items left out, if any.
I'm posting anonymously but I have a very low 4-digit ID...
I've been on Slashdot long before I ever started medical school and I always knew people talk out of their element here, but medicine is what I do and I've cringed quite a bit.
Very simply, depending on hospital policy, there are a number of scrub nurses who keep a count of sponges. They are removed in packs of 5, counted, recounted, and checked by at least two team members. As sponges are removed, they are packed in groups of 5 and discarded. A running tally is kept on a white-board by someone who isn't scrubbed in. Albeit mistakes do happen once in a while, but they are very rare.
This system seems quite complicated and I don't see any advantage in an OR, but this will ease the general public because it uses some fancy technology. What most of the public doesn't remember is doctors/surgeons are humans too. We can make mistakes so we have numerous people double-checking counts. Adding additional steps into the process with bar-code scanners only complicates things and introduces further possibility of errors. I prefer things the old fashioned way. Then again, most of my colleagues are also hell bent on sticking to the old ways.
Oh and Slashdot... please stop with the non-sense. Most of you are software or hardware nerds. You're not lawyers, doctors or surgeons. Leave the arm-chair medicine to someone more qualified such as my colleagues. Honestly, some of these comments are embarrassing.
If it ends up unreadable then what? They can't finish the surgery till they're all accounted for.
they need to make it so my car won't leave the driveway if there are still two wrenches and an old control arm setting in the engine bay
If you truly think that, then you should probably read this eye-opening article: The Checklist.
Remember, these are the guys who had an newborn "lifted" from their post-partum unit back in 2000.
Chas - The one, the only.
THANK GOD!!!
There's an AJAX joke here somewhere...
So you're saying they can't count to a hundred. Well then, that's different.
How we know is more important than what we know.
When sponges come out as blood-soak wads, how are you going to scan them? If one is left in the body, you still have to find it. I think this is definitely a case where RFID is better because it solves both problems.
The only thing barcodes can do is give you a good count at the start of the case. You scan each package of sponges you open (usually a few in each package), and you know the count is correct. Scanning the sponges as they come out is just not going to be feasible. I can't imagine any nurse wanting to have that job.
dom
So you believe something mission critical should rely on single redundancy, since only stupid people make mistakes?
I hope you are being sarcastic. If you weren't, and if your job in any way impacts public safety, please resign immediately.
Toronto-area transit rider? Rate your ride.
Ummm, is anyone else wondering how much this cost? I have an idea that costs nothing, it's a bit archaic but why don't they just count the damn sponges and equipment before and after the procedure.
Just an alarm when they leave the hospital (on their way to the morgue)? It's much cooler to see all those barcodes in the X-ray.
Does the RF cause any problems with other medical equipment? Last time I was at a hospital (a while ago, thankfully), there was a big sign saying, "No cell phones" in order to avoid interference, so I wonder how you deal with that problem.
Adding another set of steps to an already complex procedure... I'm sure that will solve the problem.
IANASurgeon, but...... couldn't they just attach string to the sponges? Or would the strings get in the way? String hanging outside patient = sponge still inside...
I can only hope that there exists a button to manually override the system and say "We know we extracted it, but the scanner does not recognize it any more". Otherwise the following procedure will be standard: Check in, Check out, insert into patient.
IMHO always equip databases with the option to say "i dont know" or "i know" otherwise people will find funny devastating ways to abuse the system.
Things such as gauze and sponges have a marking line printed on them which will show up on an x-ray. After an operation, a post-op x-ray is taken to ensure that nothing has been left behind. Really helpful in court when you've been accused of negligence.
This puts me in mind of an experience I had 4+ years ago. I had some minor surgery on my ear at a hospital in Michigan. It was a local anesthesia job because of the small area undergoing surgery and because it was on my head I was covered in whatever those blankets are called.
So to sum up the situation , I was awake with my face under a blancke for about three hours that afternoon. I learned two things about doctors that day. 1) They talk about sports, ect. while working just like everone else and 2) The worst thing you can hear while someone is performing surgery on you is "Where did that needle go?" followed by some nurses NEVER saying "oh, here it is."
If something like that can happen when highly trained professionals work on an area of a single ear then I am all for this tech.
He shouldnt have that overhead if it is automated :) Hint: Barcodes and his assistants should track the equipment, thats why he ASKS his assistants for equipment
http://www.rense.com/general79/wdx1.htm
There are problems. RFID is expensive per tag, and typically has a range of feet, where a tag still inside the patient may be detected by a scanner within the same surgical arena. No one has time to walk the new or removed sponges across the room, they go in a medical waste bin right there.
And I don't want the job of designing an RFID scanner nor RFID tags that will operate safely and reliably in a room of delicate radiological instrument, such as the X-ray and CT devices used to monitor interesting events during surgery.
I don't think your concerns are valid.
If they scan the sponge on the way in, they'll know the RFID chip is working. If it's working at that point, it's highly unlikely it will stop working during the surgery.
Cost isn't really an issue either. In large quantities RFID chips can cost as little as a $0.10. Even if a surgery uses 200 sponges, that's only $20 extra. I don't know what that translates to in medical pricing, but I'd pay an extra $20 to not have stuff left inside me.
I'm also pretty sure "having hard bits" isn't much of a problem either. As long as it soaks up what it needs to soak up, who cares? An RFID chip isn't very large, and it'd probably be embedded in the middle of the sponge anyway.
Maybe not
All the doctor would have to do is to equip his assistant with an abacus. Insert a sponge, move a bead right. Remove a sponge, move a bead left. Multiple rows for tracking multiple items, each row labeled. No barcodes, no lasers, no expensive machines.
The idea is to reduce the manpower needed to track the sponges. In a messy abdominal surgery, or open heart, you'll go through dozens. Being able to say "it's spong 12345, that was from the pack we opened last" is amazingly helpful to finding the missing sponge, and it's a lot less labor intensive than counting and double checking when the double counting is liable to introduce its own miscounts either way.
Someone who's actually used it! Cool! I hope you don't a few questions?
Don't the sponges biodegrade inside the body? Do they need to encapusalete?
Do you have any issues with the RFID tags being ruined by X-ray equipment? Or being ruined by MRI's done on patients who had to be pulled straight from surgery to the MRI chamber for whatever reason?
Not quite the doctors wristwatch joke. I had an infection occuring in my gum one time and went to the dentist, who said an old root canal had become infected. After the x-ray, they told me I had a piece of a "file" in my tooth. I was confused at first. Aparently, when I had the root canal done, the dentist was filing the inside of my tooth and the tip of the file got stuck and then (he) broke off. So of course, he filled in the tooth, leaving the file bit inside and without telling me. Apparently also this is a common practice. I had to have oral surgery (cut in through the side wall of my gum) to remove the file (hence the reason the first "dentist" left it there).
Yeah. I was pissed.
Doing otherwise makes you look like a typical fat,lazy, IGNORANT armchair skeptic who can't even be bothered to use the slightest bit of brain power their pathetic brain is capable of mustering.
But there's an operation he can have to fix that, right?
Professor Karmadillo Songs of Science
Well then, those specialist surgeons can peel off maybe ten of the thousands of dollars they're making per hour in that operating room to hire a semi-literate guy to watch the operation on closed-circuit TV and count sponges going in and out of the patient.
But I guess until I have a couple decades' vested interest in the status quo I'm not allowed to criticize, right?
I've worked with maintenance on fighter jets. There's a lot of tools used in maintenance for airplanes. Imagine what a spanner left inside a jet engine does when the engine is started up. All tools have to be accounted for before the airplane can leave for the skyes.
Humans make mistakes. You cannot trust humans. However much you train them they will make mistakes. Its called Human Factors and its part of the basic training in aviation, oil and chemical industry as well as nuclear industry which pioneered it. When you understand HF you will start thinking differently about everything. The objective is to anticipate human error and create methods to mitigate them.
Long before bar codes or RFID were invented aviation maintenence shops used a simple system which is still used today. All tools have their place, marked in highly visible red tape, outlined to the shape of the tool. So when you open the tool rack and visually scan the box - if you see red anywhere you are seeing a place where a tool is missing - simple but effective.
Of course this system is no use in surgery because you cannot put surgical implements back into the same tray where they came from. But blood covered sponges cannot be scanned with bar code readers either. RFID tags might work better but a human still has to scan everything when it goes in. Much better solution would be to RFID tag all the implements and instruments used in surgery and then scan them all at ones when they go in and come out of the surgery room. For the medical waste trays and used implement treys you'd need a more sophisticated scanner which is able to scan a hotchpotch of mixed tags all at ones.
But just like with aircraft, someone can still drop their car keys in there...
Why not insert RFID tags inside the sponges ? This way, one only has to scan the patient.
oh man, if only we were really paid hourly!!
It's the job of the nurses to make sure they get all the utensils back out.
Deleted
"This fortune soaks up 47 times its own weight in excess memory." How appropriate.
This just leads to people not caring any more ("the machine counts this stuff, doesn't it), and if anything bad happens, it would not be the persons error, but the "computers".
We should try to keep in mind that ultimately, it's ALWAYS our fault. And care a little bit more.
Well then, those specialist surgeons can peel off maybe ten of the thousands of dollars they're making per hour in that operating room to hire a semi-literate guy to watch the operation on closed-circuit TV and count sponges going in and out of the patient.
Or, I don't know, maybe instead of relying on unskilled labor they could come up with an automated solution to an apparently simple yet safety-critical task? Which is the sort of thing that machines are better at anyway? I mean would you rather trust your sponge count to a machine or to a dude who is doing the job to get booze money? Which is the whole point of the fucking article.
Toronto-area transit rider? Rate your ride.
What about Junior Mints finding their way into the patient from the observation area?
In our OR, sponges come in packs of 10. They are counted by the surgical scrub (a graduate of a 12 to 18 month technical program) and an RN (usually a college graduate) together. I have seen cases where there could absolutely be no lost sponge (i.e., small incision on an arm or leg), yet the sponge count is incorrect. This can result from either incorrectly counting the sponge at the beginning of surgery, or someone careless throwing out a sponge with a surgical towel or gown. Although I have seen surgeons go back into patients when a sponge count is incorrect at the end of surgery, more often it is the result of a miscount or throw-away. The bar-code technique mentioned above will only work if all codes are scanned at the beginning of surgery. Unfortunately, I don't see this a practical, as it would take many minutes to scan all sponges and instruments, and at $600/hour per operating room (hospital staff and equipment), it will raise costs too much. RFID tags are an interesting solution, as long as none of the tags stop functioning, and current counting methods are retained.
By the way, I'm not an anonymous coward. I'm just lazy!
Anyway, it looks like we've reached an era where it's viable to add things in people. So why not get started with implants. We could add speakers inside of people, connected to a audio jack on the outside so they can emit music. Or maybe add lamps under the skin. That could be cool
patients who get out of surgery with high tech barcode scanners still in their body...
I can see it now... Doctor tossing organs over his shoulder.... "Where'd that goddamn sponge go?!?"
This is another example of why the medical system is so ridiculously expensive. Yes, it sucks that 1600 people a year get something left inside them. However, considering all of the surgeries that take place in the USA, statistically, this is darn near perfect already. It has to be close to a one in a million chance that you get something left inside you, and so, the question is, will the RFID improve the process enough to close that gap, and if so, how much does it cost everyone to have it everywhere all the time. I think that, given, the choice, most patients would rather roll the dice and pay less to get the same surgery, then, have that added safety tax, that honestly, won't accomplish anything. Think about it, if you have doctors that can't even keep an accurate count of what went into the body, versus, what went out, then you have more problems than barcodding can help.
This is my sig.
Talk about your exhorbitant markup... How many businesses outside of medecine get a 170% markup on ther products to end consumers?
Phone. Cable. Military contractors. Things bought with your Tax money. Any domestic product that can only compete against the equivalent foreign import via government subsidies and trade tariffs.
Besides, I imagine that the 170% markup has to cover thorough training and medical insurance. If you make a single mistake while using the wand and miss a RFID for any reason, then you can cause great harm to a person and get sued for millions.
I have an idea, call me a radical. You take a slip of paper and two bowls. You count the sponges before the operation, and write the number on the paper and put the paper and the clean sponges in bowl 1. You put the used sponges in bowl 2. The operation cannot be completed until the number of sponges in the bowls matches that on the piece of paper. Come on, folks, why do you need a bar code scanner, how does that make this easier? The only advantage of the scanner is that it prevents doctors from lying and saying they counted them -- apparently it's a real possibility, or they would just count them.
Currently hooked on AMP
Somehow I see more problems arising from this barcode scanner... what if it misses one ? Will people search frantically for the sponge, or over time will they just get used to the thing being faulty and ignore it ?
How about some sort of tray with a fixed number of sponges, and at the end of the procedure you look at the tray and any empty spots, well you need to find that damned sponge!
Low-tech > high-tech, where applicable.
-Billco, Fnarg.com
The kind of business where the insurance companies will negotiate it right back down to $75 per unit at best.
$comment =~ s/($verb)\s+($noun)/IN SOVIET RUSSIA, $2 $1s YOU!/g;
Surgeon: Get me a clamp now! SHe's going to bleed to death!!!!
*beep**Beep**beep*
Assistant: Sorry doctor! It's not scanning! I can't give it to you! PRICE CHECK!!!!!
Patient: BEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEP
Your cell phone is designed to have a range of several miles. RFID is designed to have a range of about 30cm. I suspect the power levels involved are VERY different.
Nick Waterman, Sr Tech Director, #include <stddisclaimer>
Note that Louis Pasteur developed the first working rabies vaccine. In order to do this, he had to get a sample of the live virus. The best available source of the virus was the saliva of rabid dogs.
I do not know about the blood part, but Pasteur's sucesse with using rabid dogs to get a sample of the virus certainly took a lot of guts (Hold dog's mouth open, avoid being bitten, and swab the salivia out of the dog's mouth).
Also note that Louis Pasteur was one of the first physicians to realize the importance of maintaining sanitary conditions. Washing your hands is not the a recent advance in the field/newest technology, but something like 50% of hospital infections are believed to start with a nurse or other staff member not washing their hands between patients.
Using RFID at a great cost to keep track of surgical items does not have the benefit (in terms of patients) of reducing the number of infections which could be greatly reduced by making sure hands are washed.
Well, I get paid a little over $40/hour and my company charges $140/hour.
Even after accounting for payroll costs like FICA, unemployment, health insurance, and worker's comp, plus vacation days, holidays, sick days, etc., that's still more than 200% markup.
Those signs are just relics of the days of analog cell phones; today's phones don't cause any kind of interference. Every doctor I know and employee of hospitals carries a phone on them when at work. Mainly though, the signs are also to keep patient visitors from yapping on their phones in the hallways and such. IAAHITT (I Am A Hospital IT Tech)
Tell me how it is that you can check the bar codes on the sponges that are left behind in the patient, especially after the patient is closed up. At least RFID adds this check which can be done afterwards. You just make sure the chips are working both during the operation as new items are being selected for use, as well as during the preparation for the surgery in advance. Any device not working must be discarded and statistics recorded. Any manufacturer with more than 0.1% failure rate is to be fined.
now we need to go OSS in diesel cars
Sometimes you have to scan things during surgery, especially for keyhole surgery, to make sure where the instrument is relative to the target. I wouldn't expect an MRI to be so necessary during surgery, but I believe I've heard of a case of yanking someone from surgery straight to the MRI to see exactly where the stroke or blood clot had happened during surgery and follow it up with treatment ASAP.
Note that I'm not a radiologist, just an interested technical person who's worked with such people's IT needs in passing.
There is an RFID setup for this now. It seems like old news for bar coding.
You tell which one is missing by listing the number and check-out of the one that hasn't been returned. That seems a very, very basic operation for such a system.
They're using their grammar skills there.
Even if a surgery uses 200 sponges, that's only $20 extra. I don't know what that translates to in medical pricing, but I'd pay an extra $20 to not have stuff left inside me
I'd pay $20 for a doctor who can count all the way up to 200.
Is that, if you're going in for, say, surgery on your left knee, then take a black magic marker and write "wrong knee, dumbass" on your right knee. If you're having your gall bladder out, write that on your abdomen.
Point is, surgical mistakes happen.
The plural form of "anecdote" is "anecdotes", not "evidence".
If you need to collect saliva from a rabid dog, you simply shoot the dog first.
should be required to do an X-ray and/or other appropriate scan of every patient to check for leftovers at no cost to the patient.
What he said is absolutely right. I'm the OP poster. We do an x-ray at the end of a procedure within the OR to check for instruments and sponges regardless of our operating history. The cost of this is included in the surgery.
Bar codes won't work because it still involves someone keeping track of everything via scanning. A computer needs to be able to do know exactly where each instrument is and what is being done with it. Unfortunately, RFID doesn't have the reliability and cost-benefit yet to make it the technology of choice right now. Furthermore, we may be able to increase the cost of health care spending in the US, but what about the rest of the world? Tried and tested surgical old fashioned techniques will still be around for a long time to come.
I agree. If the doorway alarms ring as you're wheeling the patient out of the OR, you know you're not quite done.
Easier said than done. You really need to see the stuff we work with. The abdomen contains such a mass of organs that make it quite easy to loose the small stuff. For example, the small and large intestines are approximately 20 feet and 5 feet long respectively. As well, both are extremely floppy and slippery making it hard to see every aspect in the abdomen. Suture needles can be very small and when they break off, can be very hard to see. Added to this, there can be a lot of blood making things both stressful and messy - for example, I have been involved in dealing with many "salvage laparotomies" where the abdomen is filled with over 4 litres of blood. Further, surgeons often work in teams multitasking different aspects of the surgery with easily double digits of items inside the patient from sponges, clamps, sutures, ties, retractors and other equipment. So even though everyone is skilled, there are a lot of factors that can lead to such a potentially tragic error.
And I'd pay a lot more then $20 for a doctor to be watching my important internal bits and not trying to remember how many sponges he and 4 other specialists used over an 8-hour procedure. And sometimes things go wrong, there's a hurry, and you aren't counting so much as you are moving as quickly as possible to stop the bleeding from somewhere that shouldn't be open. Having a nice pile of scanned-in sponges waiting for use that you can instead count as they come out, when things are [relatively] nice and calm . . . that's BIG.
:-)
And to the response to my post - all good points. On further research, I feel that all my concerns are well addressed by the existing systems. Still, double-layering ain't a bad idea.
"There are four boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order." - Ed Howdershelt
Why don't they just add a six foot piece of surgical string to all surgical tools? A patient with long strings dangling out after an op will be fairly obvious.
Excuse me, but please get off my Pennisetum Clandestinum, eh!
Put a reader on each trash can. Put readers at the doorway. Put a reader on your equipment table.
To a limited depth, you can even scan the patient.
And that's how it works here in Geneva (Switzerland). In addition of the count, there's a mandatory X-Ray done after each operation, which gives a couple of critical information about the results of the surgery...
Bar code are a technical overkill and are plagued by the same kind of errors as the counting method :
- failing to count material at beginning of surgery vs. failing to swipe barcodes of material before using it.
The only kind of high tech stuff that could be useful would be RFID identifications in addition to counting.
Thus RFID signal could be used to interrogate "Are there any material still left and responding to the signal" ? Thus helping identify material that was missed during the initial count / barcode swipe.
But that would increase the cost of the material (which is disposable).
"Sufficiently advanced satire is indistinguishable from reality." - [Tips: 1DrYakQDKCQ6y52z6QbnkxHXAocMZJE61o ]
In Australia, there is a company working on RFID for surgical instruments, so you can just dump the instruments into a sensor bucket. Also means you don't have to worry about blood etc interfering with the barcodes. Sorry, can't remember the name of the company.
This seems like one case where RFID would be truly good and useful. Embed an RFID chip in each medical tool/sponge/whatever, and then pass a reader over the patient's body to check for anything still inside. Cost shouldn't really be an issue... RFID chips are cheap now, and medical equipment is so outrageously expensive that adding $0.50 each or whatever isn't really going to be a noticeable difference in price. It would allow everything that can be done with a barcode, and then some.
Remember when you would win a bunch of tickets and had to count them at the end of the day? Then, as with most kids, one day I figured out that you could count off a number like 5, and then just fold the rest of the tickets like that and just count the "rows" instead. At that age, it's pretty clever. But what really impressed me was when I would go up and redeem over 100 tickets -- I thought, the guy at the counter must appreciate how easy I've made it to count these things. But he didn't even look at them, he just threw them in a bucket that weighed the tickets to produce a count. It was pure genius.
That was a kid's pizza restaurant. You're telling me that surgical teams don't have any procedures to keep track of stuff they put in people's bodies?
...tracking of instruments and equipment (to avoid leaving them in patients as well as 'shrinkage') use embedded semi-active RFID. This not only makes the the patient beep if they leave the room with a tool in 'em (lol), it also keeps idiot staff from moving a dirty kidney pump from one patient's room to another without having first taken it to maintenance for servicing.
Loading...
Could any of the OR techs / surgeons who are here explain whether it would be possible to just have a securely fastened piece of high-vis string attached to each item used in surgery, which would trail outside the body and potentially would attach to a fixed object? How often would the string get in the way?
I am curious... you mention these wands cost about $50 ($135 patient cost)... is your facility able to pass this cost onto the patient?
I'd be all open for strings being attached to the sponges and tools.
But, if they sew my ass up after a bypass, I wouldn't want the medical team "pulling on my heart strings" to get back their sponges.
OK, maybe I'm naive (sp?) but:
Couldn't there be some cherry-picker-like device overhead? It could suspend the suction over and out of the way of the doctors, and they could (sort of like in a dental suite) pull down what they need and push aside or allow retraction of that which is not in current use. Sponges could be removed when blood-logged or useless and put in a flattened display (sort of like "Connect Four") so that EVERYone could count them (assuming no stacked sponges).
Tools attached could be retracted into a "resterilizer" unit for use on the SAME patient and then submitted to the autoclave after completion of the procedure. This might save time and obviate a need to constantly switch tools, reduce the number of tools/instruments in the surgical bay/suite, and reduce the number of trays and clutter and time wasted on counting post-op.
But, I guess then, new "medical misadventure" stats would have to accommodate/account for "instrumental expiration", aka "death due to unscheduled removal of arteries caused by clamp ripping arteries after staff tripped/tugged on accounting string attached to instrument..."
Previously: "Linux... Toward the Sunrise..." Now: "Linux... Toward the-- No, now, part of Every Sunrise"
I heard of one company that was developing an RFID scanner and chips for this very purpose, where, after surgery was done, you'd wave an RFID wand over the patient, and it would detect any remaining sponges, no matter how bloody they are. Sounds way better than this idea, I wonder what became of it...
Yes, the patient is charged(not cost,sorry about that) $135, I should have elaborated more. A high percentage of our traumas are gunshots, stabbings and such, and mostly those patients will end up falling under the indigent care umbrella, so no insurance or personal funds to pay their bills. My hospital does over $100M is indigent care per year. Also there is the cost of the sponges which I don't remember off hand, but it is less than $50 which is our charging threshold. All supplies under $50 dollars fall under the room charge(first $30 is about $2300, and about $70 per min after that for trauma cases). Sounds like a lot of money, but not when you look at the staff and equipment involved.