Dr. Jeffrey Port

New tech helps prevent surgical mishaps

August 16, 2011
By Dr. Jeffrey Port

This report originally appeared in the August 2011 issue of DOTmed Business News

Surgical disposables such as sponges, towels or gauze, are not typically given a second thought-- until one is inadvertently left inside a patient after surgery. According to recent surgical literature, it is estimated that 1,500 to 2,000 cases of retained surgical items occur each year in the United States.

There is even growing evidence that these estimates are conservative and that the actual number of retained surgical items may be greater among the nearly 30 million surgeries performed each year. Retained surgical items (RSI) are listed as a “never event” for which the Centers for Medicare and Medicaid Services and private insurers will no longer provide reimbursement.

Despite strict counting protocols, surgical sponges are sometimes unintentionally left inside patients after wound closure. The complications with surgical items left behind are significant – post-procedure infection, pain, bowel perforation, abscess, follow-up surgery and in some instances, death. Patients may also have related expenses from additional follow-up visits or medication. In addition to patient safety and care issues, incidents of RSI can also result in re-operative expenses, legal issues and a compromised reputation for the health care provider.

RSI incidents also negatively impact operating room efficiency - staff may spend an inordinate amount of time rectifying miscounts when all surgical items are not accounted for. The potential for a retained surgical item is increased in high-risk emergency and trauma situations, or “no time-to-count” procedures. However, no type of surgery is “immune” to the risk of a retained surgical item, which can also occur in laparoscopic surgeries, elective cases and even procedures performed in ambulatory settings.

Often, retained surgical items are detected after the surgical count was reported as correct. Some surgical literature suggests that up to 88 percent of cases with retained surgical items are associated with falsely reported correct counts.

In August of 2010, the Association of periOperative Registered Nurses publicized Limitations of the Surgical Count, a comprehensive Healthcare Failure Mode and Effect Analysis.

The HFMEA found that the top five causes for potential failures involving surgical counts are distraction, multitasking, not following procedures, time pressures and emergency cases. These causes account for 91 percent of surgical count failures. The presenter, Victoria M. Steelman, concludes, “Counting is not enough to prevent retained sponges 100 percent of the time, and perioperative nurses should evaluate technology for assistance.”

AORN's recently revised “Recommended Practices for Prevention of Retained Surgical Items” also include a new recommendation that perioperative nurses evaluate technology to assist with the surgical count.

The rise of adjunctive technology
This reoccurring issue led to the development of adjunctive technology which aims to eliminate the problem of retained surgical items. The first is a state-of-the art detection system designed to automatically alert OR staff if a surgical item is left behind.

The latest version of the technology features an automatic detection mat for hands-free patient scanning. The system safely and accurately detects surgical sponges, gauze or towels tagged with a radio-frequency emitting tag, through deep cavity tissue, fluids and bone. With the push of a button, the system can perform a complete scan in approximately 15 seconds, mitigating the risk of a retained sponge, even during emergency situations. Additionally, the system has a dual-detection mode with a wand that is used to perform a quick scan to rectify sponge counts and is useful for extended coverage needs in cardiac, trauma and bariatric cases.

Besides radio-frequency detection, there are other technologies available on the market to prevent RSI. Radio-frequency identification (RFID) systems utilize a large wand to both detect and count surgical materials.

Barcode counting uses uniquely-tagged items which are scanned manually. This system features reporting/performance capabilities and is very portable. However, it is not capable of locating missing surgical items to rectify a miscount or address the risk of a retained surgical item when the count otherwise appears to be accurate.

Sponge counting bags offer hospital staff an easy-to-use, low-cost way to visually account for surgical materials, though also offers no way to locate missing materials and is subject to human error due to its manual nature.

Finally, X-ray may be used in cases where a retained item is suspected, though detection is not guaranteed; it also involves more procedural time and cost.
Retained surgical items are a highly preventable error. As attention to error and patient safety grows with patients/consumers, regulatory bodies and hospitals, health care providers will continue to invest in innovative solutions that mitigate human error. Such technology can improve not only care and patient safety, but also efficiency in the OR, saving time and cost on an ongoing basis.

Dr. Jeffrey Port is an associate professor of cardiothoracic surgery and an associate attending surgeon within the Division of Thoracic Surgery at New York Presbyterian-Weill Cornell Medical Center. He is also the founder and chairman of RF Surgical Systems Inc.