What happens when a patient leaves the operating room with a pair of scissors or a sponge still inside their body? For thousands of patients each year, retained surgical items (RSIs) extend their pain and recovery time and leave hospitals’ reputations on shaky ground. Surgical counts and cavity sweeps are the traditional methods for preventing retained surgical item cases, but when hospitals are overwhelmed and staff is burnt out, there’s always room for error.
What’s the danger?
Retained surgical items can result in years of pain for patients and a high price tag for hospitals. 95% of all RSI cases have required additional care to remedy the issue, and between 2005 and 2012, at least 16 people have died due to RSI complications.
According to Nothing Left Behind, there are two groups of items that are most likely to be left behind after a surgical procedure. One group consists of medical devices, such as guidewires and catheters, and fragments of broken medical devices. Removal of these items is usually deemed more dangerous than leaving them in place.
In the other group, however, retained surgical items can cause serious problems for patients’ health. The main group consists of items that perioperative teams include in their surgical counts, like sponges, sharps and needles, and medical instruments. Needles are the most commonly miscounted surgical item, leading to increased risk of leaving needles in a patient’s body. Most needles are undetectable and unlikely to cause harm, but in the case of larger needles, patients may need surgery to remove the retained needle and relieve pain.
Soft items like sponges are most commonly left behind, and while they may not puncture internal tissue, they can cause deadly infections if not caught in time. A retained surgical sponge requires a second surgery to remove the threat, leading to even longer recovery times for patients and higher risk for infections.
Retained surgical item cases often cause major grief for hospitals. Not only do these cases drum up media attention that reflects poorly on the hospital, care costs and legal fees can be over $200,000 per patient.
How do they get left behind?
There are a number of risk factors that can lead to RSI cases, most of which can be mitigated by better planning and preparation for surgeries. When there are staff changes during a procedure or multiple surgical teams working, there is a much higher chance of miscommunications that lead to RSIs. Also, when staff experiences an unexpected change during the surgery, like in cases where they need to change their approach or add a procedure, the risk of RSI is just as high as it is during an emergency surgery. The best way to prevent RSIs in these cases is to limit any unplanned changes and unnecessary distractions, especially at critical points in the procedure.
Retained surgical item cases can also be rooted in your hospital’s safety culture as a whole. If your hospital struggles with communication, intimidation in the hierarchy, or incomplete education, your risk for RSIs is much higher.
When these communication channels break down, there is a risk for an incorrect count or even no count at all. In 15% of all retained surgical sponge cases, the patient was allowed to leave the operating room despite a known incorrect count. Whether by policy or common practice, perioperative teams with poor communication may fail to perform any surgical count at all, which leads to 5% of retained sponge cases.
Improving Surgical Counts
Typically, perioperative teams have relied on cavity sweeps and counting protocols to check for retained surgical items, and certified surgical technologists and perioperative nurses are often charged with all of the responsibility for keeping up with surgical items. However, these methods are deceptively ineffective. Even in cases where the perioperative team felt confident they had the correct count of surgical sponges, there is always room for human error. In fact, in 80% of retained sponge cases, the surgical item count had been deemed correct.
The cure for inaccurate surgical counts is the standardization of counting protocols. Hospitals should create a standard practice that invites every member of the surgical team to be responsible for the count, not just certified surgical techs and perioperative nurses. The protocol should call for a count at several critical points in a procedure, such as at the beginning to establish a baseline, before the closure of a cavity within a cavity, when a wound is closed, at the end of the procedure, and when a scrub or circulating nurse’s shift ends.
When perioperative team members find that the count is incorrect or when the procedure is at high risk for RSIs, they should also take advantage of radiographs to check for sponges or other items left behind. In conjunction with a radiologist, these scans help find the retained item or inform the surgical team’s decision to use other imaging techniques to find the RSI.
The best practice for reducing your risk for RSIs, however, is improving communication channels, especially within the surgical team. Before a potentially high-risk surgery, surgeons should use their “time-out” to remind the team of counting protocols, and during the surgery, the surgical count can be displayed on a white board. This both creates an open dialogue about keeping count of surgical items, and makes RSI prevention the responsibility of the entire team.
Patient safety should always be top of mind, and developing better practices to prevent retained surgical items is key to protecting patients. Make sure your hospital is advocating for patient safety by improving communication channels and standardizing count practices. Ultimately, it could save your hospital’s reputation and your patients in pain and suffering.
While our primary focus is preventing surgical fires, Jackson Medical is dedicated to overall patient safety in the surgical suite. For free samples of our safety device GloShield, click here.