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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."
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.
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.
Unfortunately, the process of sterilization tends to completely destroy even the simplest of technology. Most hospitals use pressurized steam autoclaves. They would have to switch to an Ethylene oxide autoclave, which has a seriously large number of risks associated with it. Not to mention that the main byproduct of a single run is the chenical equivalent of antifreeze, but having a few canisters of this stuff lying around is enough to wipe out a city block's worth of people if it popped. This might be reasonable for the factory that makes the sponges since they can closely control the process, but there are a heck of a lot of items in use in the OR, so it would only address a small number of items.
Instruments make up the bulk of the "things" used in a procedure. The emerging tech for tracking those is called dot peen marking. It's mostly designed to help the Central Supply staff (who clean and sterilize equipment) keep their sets together and track where things are in the overall process.
No you're not radical, it just doesn't work all of the time. In a typical operating room all sponges, needles, blades, and depending on the surgery being performed, instruments, are counted. This is done by direct visual inspection by at least two persons in the operating room, usually the scrub and circulating nurse. That count is recorded by the circulating nurse who is in the room the entire case. If you need new sponges, needles, or blades, those are also counted out of the package by the same two people (to avoid the uncommon situation of 9 or 11 sponges being in a ten sponge package), and that is added to the count. Then at the end of the case there are two counts, one when the surgeon begins to close, and then a final count when the procedure is to a point where no further sponges, etc. could enter the incision. This is also done by direct visual inspection of each item by two persons.
.0052%, or 1 chance in 20,000. Unfortunately, the consequences of leaving a sponge in can be fatal, so all accrediting bodies have taken the stance that there is no acceptable level of such mistakes. Retained sponges are also very costly from a medical-legal standpoint, where our broken tort system routinely hands out awards in the lower 6 figures for such events, even when there are no long term consequences for the patient, and much much more when there is true patient injury.
Believe it or not even with these safeguards there are mistakes made that leave sponges, etc. in patients. Now if the counts by the nurses are incorrect you never finish closing or leave the room without an xray of the surgical site to make sure the lost sponge isn't in the patient. In most cases of sponges left in patients the counts were correct. Example: you used 30 sponges, one is hidden in the surgical site, but when the nurses count they say they have all 30. Not likely but it happens. The only time I have ever left anything in one of my patients the counts were correct, ugh!
There were approximately 28.5 million surgical procedures performed in 2004, if there are 1500 such incidents that leaves an incidence of
Just helping to add some facts to this discussion!
cheers, ben
Never miss a good chance to shut up -- Will Rogers