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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 • Drift • Distraction • Human error • Not everything is counted • At least 88% of retained sponges had a “correct count”
Technical adjuncts • Bar-coded sponges: augmented count • Radio frequency (RF): detection of sponges • Radio frequency (RF): augmented count + detection (RFID)
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
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
Radio frequency identification • 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 • Hanging sponge clips • Numbered sponges • Other?
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
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
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
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?