Technology adjuncts to preventing retained foreign objects.

2

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”

5

Technical adjuncts

• Bar-coded sponges: augmented count• Radio frequency (RF): detection of sponges• Radio frequency (RF): augmented count +

detection (RFID)

6

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

7

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

8

• 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?