Technology adjuncts to preventing retained foreign objects.
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Is it possible to achieve and maintain zero retained foreign objects with manual and human systems alone?
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Problems with manual/human systems
• Drift• Distraction• Human error• Not everything is counted• At least 88% of retained sponges had a
“correct count”
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Technical adjuncts
• Bar-coded sponges: augmented count• Radio frequency (RF): detection of sponges• Radio frequency (RF): augmented count +
detection (RFID)
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Bar coded sponges
• Bar code on sponge• Scan in/scan out• Message when counts don’t match• Mismatched counts must be reconciled manually• If sponge not scanned in and not removed, it will not
be detected• Can keep a record of each sponge
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Radio frequency detection
• A small (size of a grain of rice) RF chip in each sponge
• Counting processes remain unchanged• Wand the patient prior to closure; a signal
indicates presence of a sponge
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• An RF chip (size of a penny) in each sponge• Scan in/scan out• Message when counts don’t match• Wand the patient prior to closure; a signal indicates
presence of a sponge• If sponge not scanned in and not removed, it will be
detected by wanding• Can keep a record of each sponge
Radio frequency identification
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Low-tech adjuncts
• Hanging sponge clips• Numbered sponges• Other?
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Possible benefits of technology
• Reduce/eliminate retained sponges and related equipment
• Reduce throughput in the OR due to less time needed to “search”
• Earlier closure of the wound• Fewer x-rays
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Possible unintended consequences of technology
• Introduce new sources of error/failure• Systems depend on user to use them
correctly• Introduce a false sense of security• Diversion of attention• Inadvertent use of “incorrect” sponge• Adding to the waste stream
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Evaluating and comparing the systems
• There will be no randomized, double-blind comparisons: even with manual systems, retained sponges occur in the order of 10-3
(~1/8,500 cases)• Bar coded sponges reduce the incidence by
an order of magnitude to 10-4 (~1/58,000 cases)
• RF is at least as effective as bar coding and may be more effective
Reference: Regenbogen, S. Surgery 2009; 145:527-35
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Critical questions
• What is the likelihood that the system chosen will get you to zero retained sponges?
• What is the likelihood that the system will introduce new errors that will offset the gains?
• What is the impact on workflow?• What usability issues does the system have? Is it
intuitive? Does it require specialized training or technique?
• What does the system cost?• What is the longevity of the system and investment:
what if something better comes along next year?