For centuries retained surgical items were physically counted to ensure that none were left inside the patient after an operation but new technology has made it possible that this never happens again. Generally undergoing surgery is complicated and scary enough for most people but just imagine being stuck with things like needles, sponges, retractors, blades and other items inside your body. Recently, however, the University of Michigan Health System has developed an innovative system that eradicates mistakes like leaving retained surgical items and foreign objects behind in the body of patients after surgery.
Since sponges are one of the more common retained surgical items to be left behind after surgery, the University of Michigan has replaced the ordinary ones with bar coded sponges avoid this and this eliminates the surgeons counting the items used as a computer does it for them. Each bar code on each sponge is scanned before and after use to keep an inventory for each operation. If the scanned sponges do not tally after an operation, the surgeon is immediately alerted to have the item removed from the freshly operated area.
Ella Kazerooni, M.D., M.S., professor of radiology at the U-M and associate chair of clinical affairs at the U-M Health System, explained: “Having a foreign object left behind during surgery is something we consider a ‘never event.’ It’s something that should never happen. Unfortunately in complex cases, surgical cases that involve emergencies or in very large patients, items can be left behind in the body and we want to do every thing we can to prevent that.”
“The practice of manually counting is a long-standing practice within the OR. Surgical teams may count more than a hundred items in a single case.”
Another way that the University of Michigan has been able to decrease the incidence of retained surgical items after surgery is by switching to electronic radiology as opposed to the manual system used in the past. This enables the surgical team to conduct an x-ray while the patient is still in theater and to act quickly to remove the foreign objects.
Some examples of the kind of items left behind include; needles for suturing, sponges used to keep the incision area open to improve the view of the surgical field, and instruments used during procedures. However, radiology can play a vital role in preventing surgical objects from accidentally being left behind. In addition to identifying metal items, X-rays can also identify soft goods. A radiologist can see the bar-coded sponges on an X-ray as they contain a radiopaque tag.
Is there any excuse for retained surgical items? This is unacceptable as removing it exposes the patient to more anesthesia and risk as it requires additional surgery. This in turn equates to more pain and a longer recovery period. But if retained surgical debris is not discovered in time it may well cause wrongful death, infection and injury.
The problem of surgical items being inadvertently left in various body spaces after an operation has been with us since the practice of surgery began. Retained Surgical Items (RSI) is the preferred term rather than retained foreign bodies or objects. Foreign objects include swallowed pennies, pins, shrapnel, bullets and other objects while surgical items are the tools and material that we use in procedures to heal not to harm. Retained surgical items are a surgical patient safety problem.
By the end of 2011 many hospitals had been able to accomplish the goal of having zero retained sponges for at least a year. There are a sufficient number of good systems in place to prevent this event from occurring and now it requires the necessary behavior changes to employ safer practices. Although mistakes are unavoidable during equipment count-in or count-out procedures if hundreds of sponges are used, for example, one can be overlooked; the bigger problem is under-staffing which can also result in retained surgical items. Conversely, crowded operating rooms can lead to confusion and in addition to the surgical staff, nursing students; medical students and residents may be present as observers or participants, however, there is absolutely no excuse for retained surgical items to occur as it is tantamount to negligence.
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