From the August 2011 issue of HealthCare Business News magazine
By Dr. Jeffrey Port
This report originally appeared in the August 2011 issue of DOTmed Business News
Surgical disposables such as sponges, towels or gauze, are not typically given a second thought-- until one is inadvertently left inside a patient after surgery. According to recent surgical literature, it is estimated that 1,500 to 2,000 cases of retained surgical items occur each year in the United States.
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There is even growing evidence that these estimates are conservative and that the actual number of retained surgical items may be greater among the nearly 30 million surgeries performed each year. Retained surgical items (RSI) are listed as a “never event” for which the Centers for Medicare and Medicaid Services and private insurers will no longer provide reimbursement.
Despite strict counting protocols, surgical sponges are sometimes unintentionally left inside patients after wound closure. The complications with surgical items left behind are significant – post-procedure infection, pain, bowel perforation, abscess, follow-up surgery and in some instances, death. Patients may also have related expenses from additional follow-up visits or medication. In addition to patient safety and care issues, incidents of RSI can also result in re-operative expenses, legal issues and a compromised reputation for the health care provider.
RSI incidents also negatively impact operating room efficiency - staff may spend an inordinate amount of time rectifying miscounts when all surgical items are not accounted for. The potential for a retained surgical item is increased in high-risk emergency and trauma situations, or “no time-to-count” procedures. However, no type of surgery is “immune” to the risk of a retained surgical item, which can also occur in laparoscopic surgeries, elective cases and even procedures performed in ambulatory settings.
Often, retained surgical items are detected after the surgical count was reported as correct. Some surgical literature suggests that up to 88 percent of cases with retained surgical items are associated with falsely reported correct counts.
In August of 2010, the Association of periOperative Registered Nurses publicized Limitations of the Surgical Count, a comprehensive Healthcare Failure Mode and Effect Analysis.
The HFMEA found that the top five causes for potential failures involving surgical counts are distraction, multitasking, not following procedures, time pressures and emergency cases. These causes account for 91 percent of surgical count failures. The presenter, Victoria M. Steelman, concludes, “Counting is not enough to prevent retained sponges 100 percent of the time, and perioperative nurses should evaluate technology for assistance.”