Technology adjuncts to preventing retained foreign objects'

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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 dont 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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Radio frequency identification

• An RF chip (size of a penny) in each sponge
• Scan in/scan out
• Message when counts dont 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

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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 145527-35

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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?