In order to avoid leaving surgical items, such as needles, sponges, retractors, blades and other items used during operations, in the body, surgical teams have relied on counting and recounting the items for decades. However, a new system using innovative technologies has been developed by the University of Michigan Health System. The new system reduces potentially serious medical errors, by ensuring that no foreign objects are accidently left in the patient’s body during surgery.
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 everything we can to prevent that.”
Bar-coded sponges are just one of the techniques practiced at the U-M, in order to prevent retained surgical objects. One of the most prevalent items left behind during surgery are sponges, however with bar-coded sponges, computers help surgeons do the counting. The sponges are scanned when they are used, and then scanned again when removed from the patient’s body. If a sponge has been scanned for use and not scanned when removed, the surgeon knows to search the surgical field for the item which may not have been removed.
Furthermore, the U-M switched from a manual radiology order to an electronic order system, in order to quickly call for help to find retained objects. X-rays are carried out while the patient is still in the operating room to find retained items.
Shawn Murphy, R.N., nursing director of University of Michigan Health System operating rooms, said:
“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.”
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 accidently 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.
Kazerooni, explained:
“The challenges of involving radiology in the operation room are mostly ones of communication and timing. First, the surgical team needs to recognize that there may be a possible retained foreign object. Once they do, there needs to be good communication with the radiology department to get the technologist into the OR as quickly as possible. We don’t want to delay the surgery or lengthen the anesthesia time unnecessarily.”
One of the leading patient safety goals of the U-M’s Department of Surgery is to reduce the number of times surgical instruments left behind in the body.
Each year, the U-M carries out approximately 46,000 surgical procedures, and performs some of the most advanced cancer, heart, transplant and vascular surgeries in the country. Part of the initiative to prevent retained surgical items is operating rooms in the Health System’s University Hospital, U-M Cardiovascular Center and C.S. Mott Children’s Hospital.
Since the system has been in place, the U-M has not had an event in over a year, and intraoperative imaging continues to improve.
Kazerooni explains:
“The University of Michigan is leading the way in reducing retained foreign objects in the operating room. It’s a combination of using new technologies as well as culture change, teamwork and collaboration that’s making it possible.”
Written by Grace Rattue