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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."
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
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.
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....
I have enough trouble getting these things to scan under ideal conditions at the grocery store let alone after being pulled used and bloodied from the body of a patient.
Sanity is a sandbox. I prefer the swings.
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)
bar code scanners aren't all that high-tech anymore, are they?
Well, to be fair, the person who wrote the article was George H. W. Bush. (1992)
The theory of relativity doesn't work right in Arkansas.
http://www.forumpix.co.uk/i.php?I=1197185097
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.
Hey, whenever I walk into the local Weis grocery store, I feel like I'm in a sea of technology. That or rotten produce, I can't tell the difference.
-The world would be a better place if everyone had a hoverboard
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.
let alone after being pulled used and bloodied from the body of a patient. .. in the middle of a critical surgery ..
Alas doctors would rather a high tech approach rather than just a good old fashioned checklist of procedures
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.
I think that an RFID would be great too. Have one on each surgical instrument and after everything is complete and you're ready so sew them back together you run a quick scan over the person's body to check for any RFID. That might be over generalized since I'm not a doctor, but I'm sure that everyone here gets the idea.
"Some books contain the machinery required to create and sustain universes."-Tycho
If you truly think that, then you should probably read this eye-opening article: The Checklist.
Meh. Previously, they were supposed to keep count of how many they inserted. If they forget to scan one on the way in, same problem. What they ought to do is open packs of 10 at a time. If they don't have 10 or 20 (clean and used) when they're done, then they know they have a problem. They could recycle the unused ones by sending them to some orderlies to repack them into 10s, and verify it by weight. $300 for a good electronic balance, and they have a system that will actually work. Sometimes low-tech is the appropriate solution.
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.
How do you scan a bar-code on a sponge designed to soak up blood and yuck? That might be the high-tech part of the scanner.
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.
Bar codes aren't high-tech, but applying them to a number of discrete objects in a highly variable environment with a lot of occlusions and weird angles to solve a very relevant medical problem IS novel and definitely worthwhile.
Price check in OR 3. Price check in OR 3.
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.
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.
"Oh my god. Do you call yourself a surgeon!?"
"Well, no, Mrs. Smith, I'm the IT trainee assigned to the OR. But - I AM a certified Microsoft System Engineer."
In Soviet Russia, surgery is for implanting RFID tracking objects in you!
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.
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.
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.
Point taken, I figured that might be a problem. Although I also have another suggestion, what about using a very weak radio isotope embedded in the instruments? That would be fairly easy to scan for as well and since it doesn't have any kind of circuit in it I would think that's it's sterilization proof as well. I'm none too sure about the details, but there has to be some kind of very weak, non-poisonous isotope out there that fits the bill. What I'm getting at is that there has to be some way for a doctor or member of the staff to do a very quick check over the body of the patient prior to finishing the surgery that hasn't been tried yet. I'm non genius and I'm sure someone smarter than me has thought of all the things that I've mentioned, but awareness of the possibilities is important methinks.
"Some books contain the machinery required to create and sustain universes."-Tycho
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
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!
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).
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