Technology adjuncts to preventing retained foreign objects
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Technology adjuncts to preventing retained foreign objects. Is it possible to achieve and maintain zero retained foreign objects with manual and human systems alone?. Problems with manual/human systems. Drift Distraction Human error Not everything is counted

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Is it possible to achieve and maintain zero retained foreign objects with manual and human systems alone?


Problems with manual human systems
Problems with manual/human systems objects with manual and human systems alone?

  • Drift

  • Distraction

  • Human error

  • Not everything is counted

  • At least 88% of retained sponges had a “correct count”


Technical adjuncts
Technical adjuncts objects with manual and human systems alone?

  • Bar-coded sponges: augmented count

  • Radio frequency (RF): detection of sponges

  • Radio frequency (RF): augmented count + detection (RFID)


Bar coded sponges
Bar coded sponges objects with manual and human systems alone?

  • 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


Radio frequency detection
Radio frequency detection objects with manual and human systems alone?

  • 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


Radio frequency identification
Radio frequency identification objects with manual and human systems alone?

  • 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


Low tech adjuncts
Low-tech adjuncts objects with manual and human systems alone?

  • Hanging sponge clips

  • Numbered sponges

  • Other?


Possible benefits of technology
Possible benefits of technology objects with manual and human systems alone?

  • 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


Possible unintended consequences of technology
Possible unintended consequences of technology objects with manual and human systems alone?

  • 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


Evaluating and comparing the systems
Evaluating and comparing the systems objects with manual and human systems alone?

  • 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


Critical questions
Critical questions objects with manual and human systems alone?

  • 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?


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