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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
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.
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)
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.
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.
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.
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.
Price check in OR 3. Price check in OR 3.
Complete 100% assertions like that never hold up, but there are a couple of elements of real world practice to bear in mind. I'm speaking as an IT guy, not a surgeon, but some things stay fairly generic because it's just the way it is.
Most importantly, a procedure as documented normally extends beyond the core activity itself. The paperwork is often part of it, or at least the basic checks e.g. "have we left any sponges in the body?" If the surgeon had to leave immediately due to some other emergency, everyone else doesn't suddenly assume the procedure is over. There's still the anaesthetist, the nurses, etc. If everyone leaves before counting the sponges, and complications developed, then it would be fair to say at any subsequent inquest that the procedure was not completed, and the shit hits the fan.
Second, "accounted for" tends to get a bit loose as well. Often it doesn't mean physically verified, but simply noted e.g. "Sponge 4 - stolen by bizarre lunatic who came in, grabbed the sponge, and ran out shouting "I've got the flag!". Or simply "Sponge 4 - lost" could technically be accounted for. Clearly "lost" in the context of surgery is rather more important than that of a stock check of frozen fish in a supermarket, and therefore there may be all sorts of checks in place. But at the end of the day, life has to move on, and any bureaucratic system eventually gives someone the authority to sign something off, no matter how important. "Missing, presumed dead" is a classic example.
One of the reasons behind many scandals (insert your politically prejudiced example here) is that things get signed off without due authority, or done in secrecy, or there is no inquest to check exactly *how* things were accounted for, and so on. But the goal is generally: we have a procedure that we know works, everyone has to follow it, and relevant paperwork done. If it is followed and things go horribly wrong, you're much less open to blame if you've followed procedure, and if it is not followed you might find yourself in deep shit *even if* the core activity was performed as well as could be.
As an IT guy with many of the classic failings, I often forget this and assume that simply because I've done a good job, then my work is done. This has (and will no doubt again) come to bite me in the ass when e.g. a hard drive failure leads to making a site visit that could have been avoided if I'd all the paperwork handy to cover said ass.
In the case of surgery, which is a high risk activity conducted by highly trained and experience staff in a controlled environment, I would expect that the instances of the procedure not being completed are rare and the initial statement is damn near 100% true in the "physical" sense, not just the "bureaucratic" sense.
"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!
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.
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.
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