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Bar Codes Keep Surgical Objects Outside Patients 269

Posted by Zonk
from the that's-just-where-I-like-them dept.
Reservoir Hill writes "Every year about 1,500 people in the US have surgical objects accidentally left inside them after surgery, according to medical studies. To prevent this potentially deadly problem, Loyola University Medical Center is utilizing a new technology that is helping its surgical teams keep track of all sponges used during a surgical procedure. Each sponge has a unique bar code affixed to it that is scanned by a high-tech device to obtain a count. Before a procedure begins, the identification number of the patient and the badge of the surgical team member maintaining the count are scanned into the counter. When a sponge is removed from a patient, it is scanned back into the system. A surgical procedure cannot end until all sponges are accounted for."
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Bar Codes Keep Surgical Objects Outside Patients

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  • by The Hobo (783784) on Sunday December 09, 2007 @02:47AM (#21629307)
    Reference counting. Insert obvious garbage collection joke here.

    Tee hee.
    • by OldManAndTheC++ (723450) on Sunday December 09, 2007 @06:00AM (#21629933)
      I'm coming up blank. Got any pointers?
    • A 39 cent solution (Score:5, Insightful)

      by wealthychef (584778) * on Sunday December 09, 2007 @10:41AM (#21630959)
      I have an idea, call me a radical. You take a slip of paper and two bowls. You count the sponges before the operation, and write the number on the paper and put the paper and the clean sponges in bowl 1. You put the used sponges in bowl 2. The operation cannot be completed until the number of sponges in the bowls matches that on the piece of paper. Come on, folks, why do you need a bar code scanner, how does that make this easier? The only advantage of the scanner is that it prevents doctors from lying and saying they counted them -- apparently it's a real possibility, or they would just count them.
      • by ben_white (639603) <ben@nosPam.btwhite.org> on Sunday December 09, 2007 @11:06AM (#21631111) Homepage
        No you're not radical, it just doesn't work all of the time. In a typical operating room all sponges, needles, blades, and depending on the surgery being performed, instruments, are counted. This is done by direct visual inspection by at least two persons in the operating room, usually the scrub and circulating nurse. That count is recorded by the circulating nurse who is in the room the entire case. If you need new sponges, needles, or blades, those are also counted out of the package by the same two people (to avoid the uncommon situation of 9 or 11 sponges being in a ten sponge package), and that is added to the count. Then at the end of the case there are two counts, one when the surgeon begins to close, and then a final count when the procedure is to a point where no further sponges, etc. could enter the incision. This is also done by direct visual inspection of each item by two persons.

        Believe it or not even with these safeguards there are mistakes made that leave sponges, etc. in patients. Now if the counts by the nurses are incorrect you never finish closing or leave the room without an xray of the surgical site to make sure the lost sponge isn't in the patient. In most cases of sponges left in patients the counts were correct. Example: you used 30 sponges, one is hidden in the surgical site, but when the nurses count they say they have all 30. Not likely but it happens. The only time I have ever left anything in one of my patients the counts were correct, ugh!

        There were approximately 28.5 million surgical procedures performed in 2004, if there are 1500 such incidents that leaves an incidence of .0052%, or 1 chance in 20,000. Unfortunately, the consequences of leaving a sponge in can be fatal, so all accrediting bodies have taken the stance that there is no acceptable level of such mistakes. Retained sponges are also very costly from a medical-legal standpoint, where our broken tort system routinely hands out awards in the lower 6 figures for such events, even when there are no long term consequences for the patient, and much much more when there is true patient injury.

        Just helping to add some facts to this discussion!
        • by Just Some Guy (3352) <kirk+slashdot@strauser.com> on Sunday December 09, 2007 @12:51PM (#21631819) Homepage Journal

          I was a Navy operating room tech. As a junior enlisted, I yelled at an officer exactly one time: when a new anesthesiology resident saw a sponge on the floor and helpfully threw it away in his own trashcan (which the nurses and techs aren't responsible for). At the end of the case when the count was off, the surgeon proceeded to pitch a royal conniption - and justifiably so. We tore the room apart, went through the trash, went through the biohazard trash (filled with bloody stuff), dismantled every piece of equipment that it could possibly have fallen into, and generally panicked. After about 20 minutes of frantic searching, the new guy walked in and asked us very sympathetically what was wrong. He went white as we told him and ran to fetch his garbage, thus rescuing us from The Wratch Of The Surgeon.

          We asked him to please not do that again.

          But this barcode scheme wouldn't have helped. We already knew we were missing exactly one sponge, and it wouldn't have told us that it had been taken from the surgical suite. As much as I hate to say it, this is well beyond the point of diminishing returns and may even be more dangerous than the current system. This will require more labor, and thus either cause surgeries to take longer (exposing patients to risks of longer anesthesia) or raise surgical headount and costs and thereby make medical care even harder to get for some people. At some point, you have to say "the current level of risk is just about as good as we can get it" and move on.

          You can get risk levels arbitrarily low given an infinite amount of resources. We don't have infinite resources.

          • Re: (Score:3, Insightful)

            by raddan (519638)
            This sounds like an actual legitimate use for RFID tags. It would be a fairly simple matter then to find out if an instrument was left in a patient.
        • Re: (Score:3, Interesting)

          by Manchot (847225)
          Retained sponges are also very costly from a medical-legal standpoint, where our broken tort system routinely hands out awards in the lower 6 figures for such events, even when there are no long term consequences for the patient, and much much more when there is true patient injury.

          This is one reason that the whining of people about tort reform doesn't carry too much weight with me. If you can charge someone 6 figures to perform a surgery, why should you be surprised that juries are willing to hand out awa
          • Re: (Score:3, Insightful)

            by FLEB (312391)
            I'd think part of the problem is a feedback loop-- Doctors can charge more, so both the value of their services, the value of their mistakes (as a consequence of both "refund cost" and "repair cost"), as well as the apparent ability for them to compensate mistake victims go up. Furthermore, the value of human health is a very difficult thing to place a dollar amount on-- While the cost to restore health is often appraisable, the value of the healthy state itself (and the value of lost health) is rarely so.
            • Re: (Score:3, Insightful)

              by ben_white (639603)

              I'd think part of the problem is a feedback loop-- Doctors can charge more, so both the value of their services, the value of their mistakes (as a consequence of both "refund cost" and "repair cost"), as well as the apparent ability for them to compensate mistake victims go up.

              You've been rated insightful, but you are way off the mark.

              The feedback loop doesn't include the doctors. Doctor fees have seen decline nearly every year in the last decade. For example Medicare reduced the average physician reimbursement rate 4.4% beginning Jan 1, 2007, while the cost of running a practice continues to increase every year by nearly twice the rate of inflation (my employees seem to think they deserve cost of living raises); you do the math. Before you post a comment about how most pe

      • Simple Count. (Score:3, Interesting)

        by DrYak (748999)

        You count the sponges before the operation, and write the number on the paper and put the paper and the clean sponges in bowl 1. You put the used sponges in bowl 2. The operation cannot be completed until the number of sponges in the bowls matches that on the piece of paper

        And that's how it works here in Geneva (Switzerland). In addition of the count, there's a mandatory X-Ray done after each operation, which gives a couple of critical information about the results of the surgery... ...but can also help fin

  • A surgical procedure cannot end until all sponges are accounted for.

    Somehow I can't totally believe that. True, it will obviously remind them and stop them from leaving them accidentally, but what if the doctor just leaves? Does it lock the door?
    </sadattemptandhumor>

    Seriously though, what if there's a fire or something and not all the sponges can be accounted for? What if a doctor accidentally walks out with one? I agree that this will be useful a lot of the time, but it looks to me like their

    • by ContractualObligatio (850987) on Sunday December 09, 2007 @04:55AM (#21629723)
      Complete 100% assertions like that never hold up, but there are a couple of elements of real world practice to bear in mind. I'm speaking as an IT guy, not a surgeon, but some things stay fairly generic because it's just the way it is.

      Most importantly, a procedure as documented normally extends beyond the core activity itself. The paperwork is often part of it, or at least the basic checks e.g. "have we left any sponges in the body?" If the surgeon had to leave immediately due to some other emergency, everyone else doesn't suddenly assume the procedure is over. There's still the anaesthetist, the nurses, etc. If everyone leaves before counting the sponges, and complications developed, then it would be fair to say at any subsequent inquest that the procedure was not completed, and the shit hits the fan.

      Second, "accounted for" tends to get a bit loose as well. Often it doesn't mean physically verified, but simply noted e.g. "Sponge 4 - stolen by bizarre lunatic who came in, grabbed the sponge, and ran out shouting "I've got the flag!". Or simply "Sponge 4 - lost" could technically be accounted for. Clearly "lost" in the context of surgery is rather more important than that of a stock check of frozen fish in a supermarket, and therefore there may be all sorts of checks in place. But at the end of the day, life has to move on, and any bureaucratic system eventually gives someone the authority to sign something off, no matter how important. "Missing, presumed dead" is a classic example.

      One of the reasons behind many scandals (insert your politically prejudiced example here) is that things get signed off without due authority, or done in secrecy, or there is no inquest to check exactly *how* things were accounted for, and so on. But the goal is generally: we have a procedure that we know works, everyone has to follow it, and relevant paperwork done. If it is followed and things go horribly wrong, you're much less open to blame if you've followed procedure, and if it is not followed you might find yourself in deep shit *even if* the core activity was performed as well as could be.

      As an IT guy with many of the classic failings, I often forget this and assume that simply because I've done a good job, then my work is done. This has (and will no doubt again) come to bite me in the ass when e.g. a hard drive failure leads to making a site visit that could have been avoided if I'd all the paperwork handy to cover said ass.

      In the case of surgery, which is a high risk activity conducted by highly trained and experience staff in a controlled environment, I would expect that the instances of the procedure not being completed are rare and the initial statement is damn near 100% true in the "physical" sense, not just the "bureaucratic" sense.
  • by psued0ch (1200431) <sunoij6@gmail.com> on Sunday December 09, 2007 @02:56AM (#21629339)
    We all make mistakes, but surgeons today should have enough skill to ensure that objects are not left in the body in the first place. It seems like another scenario where use of advanced technology replaces basic skills that a human should have in these situations.
    • by Elrond, Duke of URL (2657) <JetpackJohn@gmail.com> on Sunday December 09, 2007 @03:15AM (#21629421) Homepage

      We do all make mistakes, and surgeons are no exception.

      I had a laproscopic procedure done a few years back and in the end I developed and abdominal infection. The surgeon had done his work, as had the hospital, but bacteria are microscopic. And, sometimes, the procedure just has a mistake.

      As best as the surgeon could guess, there must have been some bacteria on one of the instruments despite all of the precautions. Shortly afterwards, though he didn't say so, I could tell that he was worried. Once I made it clear that I had no intentions of suing him, he became far more relaxed.

      I don't blame him, and told him as much. Sometimes, even when you follow all of the proper procedures, things don't turn out right. It's unfortunate, but it doesn't mean he did it through incompetence or malice. Perhaps I would feel differently if it hadn't turned out well enough in the end, but given the amount of medical procedures I've been through, I expect I would have felt this way regardless.

      • by truesaer (135079) on Sunday December 09, 2007 @04:03AM (#21629581) Homepage
        We do all make mistakes, and surgeons are no exception.


        It always amazes me how resistant people are to this idea. Think about how many times it takes you to get some code working. Sure, you're not as worried about it working the first compile as a surgeon but we all know that little mistakes are inevitable. It's human nature. These kinds of systems are very sensible because they provide a mechanical way for staff to avoid a common medical error. It shouldn't even cost all that much once widely used.


        I recently read a pretty interesting book called "Complications," sort of a blog style book about medical errors, mysterious ailments, etc. The author, who is a surgeon, recounts a list of medical errors that sound horrible...metal instruments left in a patient after surgery, incorrect dosages of medication given, etc. In some cases the patient in question died. The source of the mistakes? An informal survey of mistakes made in the past couple of months by his colleagues at Harvard.


        Even cream of the crop doctors will screw up occasionally, and they see dozens of patients daily. One of the interesting points of the book was that there is very little scientific study on medical errors and how to best avoid them.

        • by Puff of Logic (895805) on Sunday December 09, 2007 @05:24AM (#21629819)

          One of the interesting points of the book was that there is very little scientific study on medical errors and how to best avoid them.
          Of course there isn't a lot of study, because the ever-more litigious state of modern medicine has created an atmosphere in which a physician/surgeon cannot say "I screwed up, let's learn from this" for fear of being sued into oblivion. While I certainly acknowledge that doctors should be accountable for true malpractice, we hold them to a standard of perfection that would be considered absolutely ridiculous in any other field. Here's a thought: how about no lawyer is allowed to file suit against a physician (on behalf of a patient) unless that lawyer has never screwed up a piece of paperwork. Alternatively, we could create a climate in which lawyers can be sued by their clients for the "pain and suffering" of losing a court case if the lawyer didn't pursue absolutely every available avenue, even the ones with a very poor likelihood of success.

          See how completely unreasonable that would be? I should be clear that I'm not bagging on lawyers here, but using them as an example of how another profession might be held to ridiculous standards of perfection. M&M conferences would be a far more effective learning tool if there was no sense of blame, and doctors could freely help their colleagues learn from prior mistakes.
    • We all make mistakes, but surgeons today should have enough skill to ensure that objects are not left in the body in the first place.

      What is your profession, that you have zaro bugs in? Name one profession that doesn't have it's fuckups.

      That said, surgery is in my opinion a minor event. If a surgeon fucks up, somebody dies. Big deal, and there will be some medical explanation to get the offending surgeon off the hook anyway. If an engineer fucks up, two hundred people die. And there will be millions of dollars worth of inquiries to find and hang that same engineer.

      I should have gone to med school.

    • We all make mistakes, but surgeons today should have enough skill to ensure that objects are not left in the body in the first place.

      That's your belief. That's not a fact. There is a difference.

      It seems like another scenario where use of advanced technology replaces basic skills that a human should have in these situations.

      It seems like a case of using advanced technology to solve an ongoing problem.

    • Have you ever been inside an OR during surgery or seen a sponge? I spent two months watching my boss perform open heart surgery. Let me tell you, there is a great deal of blood. The sponges are inside the thoracic cavity during the procedures, and there is so much blood that they almost appear to be part of the tissue. The ones I saw also weren't that big, and they look nothing like the sponges we use in the shower. Certainly this type of incident should not happen, and the OR staff works hard to keep
    • What a magnificant hospital administrator / legal counsel you would make!

      "I'm sorry your wife died, Mr Thompson. According to our procedures, our surgeons should never make any mistakes, so the hospital has done everything we possibly could. The risk of someone dying simply doesn't justify the huge effort required to count sponges. Perhaps you can sue the surgeon himself for not being perfect".

    • I sat in and watched a relative getting open heart surgery. It's messy, it's nasty, and it goes on for hours. And other surgical staff may be asked to help: a nurse with small hands may be asked to hold something in place in a delicate bit of work, because her fingers may fit better.

      Good surgery is not a one-man operation, it's a team. And teams can lose track of small objects.
  • hah (Score:5, Funny)

    by flonker (526111) on Sunday December 09, 2007 @03:05AM (#21629379)
    Well, I laughed at the bottom of the post where it said

    (tagging beta)
  • Wouldn't RFID be more appropriate than bar codes in this situation?
    • There are problems. RFID is expensive per tag, and typically has a range of feet, where a tag still inside the patient may be detected by a scanner within the same surgical arena. No one has time to walk the new or removed sponges across the room, they go in a medical waste bin right there.

      And I don't want the job of designing an RFID scanner nor RFID tags that will operate safely and reliably in a room of delicate radiological instrument, such as the X-ray and CT devices used to monitor interesting events
  • in state hospitals. But not just with sponges. Also with forceps and other surgical instruments :-S
  • RFID (Score:5, Informative)

    by RandomLinguist (712026) <(onelinguist) (at) (gmail.com)> on Sunday December 09, 2007 @03:24AM (#21629455) Homepage
    An RFID solution for this problem already exists. Surgical equipment and gauze and sponges are manufactured with a tag inside, or sewn on. A wand shaped like a loop is waved over the patient before the surgeon closes to make sure all foreign material is removed.
  • Surely this would be one good use of RFID. Then you could scan the disposal, and scan the patient, and make sure everything was detected in one and nothing left in the other.

    I'd hate to be the one trying to scan barcodes from blood-soaked sponges. Isn't some equipment too small to barcode?
  • RFID has already been suggested (here is the old Slashdot story [slashdot.org]) and sounds much more convenient to use.
  • Alas doctors would rather a high tech approach rather than just a good old fashioned checklist of procedures [newyorker.com]
    • by Chas (5144)
      Again, with dozens (or hundreds) of pieces of equipment during a surgery, that's not always feasible.

      And people can mis-count.
  • Why not use RFID ?
    That way, one could even find out the details of the items left out, if any.
  • I'm cringing... (Score:5, Informative)

    by Anonymous Coward on Sunday December 09, 2007 @03:42AM (#21629513)
    I'm posting anonymously but I have a very low 4-digit ID...

    I've been on Slashdot long before I ever started medical school and I always knew people talk out of their element here, but medicine is what I do and I've cringed quite a bit.

    Very simply, depending on hospital policy, there are a number of scrub nurses who keep a count of sponges. They are removed in packs of 5, counted, recounted, and checked by at least two team members. As sponges are removed, they are packed in groups of 5 and discarded. A running tally is kept on a white-board by someone who isn't scrubbed in. Albeit mistakes do happen once in a while, but they are very rare.

    This system seems quite complicated and I don't see any advantage in an OR, but this will ease the general public because it uses some fancy technology. What most of the public doesn't remember is doctors/surgeons are humans too. We can make mistakes so we have numerous people double-checking counts. Adding additional steps into the process with bar-code scanners only complicates things and introduces further possibility of errors. I prefer things the old fashioned way. Then again, most of my colleagues are also hell bent on sticking to the old ways.

    Oh and Slashdot... please stop with the non-sense. Most of you are software or hardware nerds. You're not lawyers, doctors or surgeons. Leave the arm-chair medicine to someone more qualified such as my colleagues. Honestly, some of these comments are embarrassing.
    • Re: (Score:3, Funny)

      by truesaer (135079)
      Well you've certainly picked up the legendary surgeon asshole-ego in medical school. Well done!
      • Re: (Score:2, Insightful)

        by Anonymous Coward
        He may have an ego, but nothing he has said is wrong.
        • Re: (Score:3, Funny)

          by Anonymous Coward
          She did say something wrong. Her ID isn't in "the low 4 digits"; I checked her IP and she's a sock puppet run from a well known medical school.

          I know this because my ID is in the low 2 digits.

          Of course I'm posting anonymously to protect the reputation of the admin staff.
      • Re:I'm cringing... (Score:4, Insightful)

        by Valar (167606) on Sunday December 09, 2007 @12:03PM (#21631419)
        Why, because he said that if you aren't a doctor you aren't qualified to discuss whether a particular addition to surgical procedure is meritorious? And that if you aren't a lawyer you should avoid giving out legal advice?

        That's not ego, it's simply the truth. In both cases, you are dealing with incredibly complex fields that contain a lot of specialist information. People spend 4 years _preparing_ to study these, and then another 4 years _studying_ them, and then years of internships, etc, before anyone will trust you to work on/for them unattended. I think because we have access to so much information right at our finger tips, we tend to forget that we aren't the specialists. I've learned enough about medicine to spot common diseases and to use the proper terminology to describe my symptoms. But you know what? If I'm sick and it doesn't go away after a week, I go to see a doctor I trust.

        On a side note, I see this a lot whenever economics or investment comes up on /. This happens to have become my specialty, through a long and winding road. I'll admit that it doesn't require quite as much specialist training, but modern money management is complex stuff. Yet all the time on /. I read people getting the basics wrong, and with great fervor (like a recent conversation regarding stock market yields and the inflation rate where a poster came to the conclusion that nobody but Warren Buffett makes money in the stock market). I get called an idiot when I correct them. It makes me laugh.
    • by nbauman (624611)
      I can't believe how many posts I had to go through to find somebody who actually knows what he's talking about.

      Adding additional steps into the process with bar-code scanners only complicates things and introduces further possibility of errors.

      Yes, you'd think computer nerds would know that. Don't they study engineering any more?
      There actually are studies (in Archives or Annals, I always mix them up) that found that automating medical procedures sometimes causes worse outcomes. It's harder to type a prescription into a computer than write it by hand.

      Oh and Slashdot... please stop with the non-sense.

      Yes, please.
      Oh, forget it. It's hopeless.

    • by hyades1 (1149581)

      "Oh, and Slashdot...please stop with the non-sense (sic). most of you are software or hardware nerds. You're not lawyers, doctors or surgeons. Leave the arm-chair medicine to someone more qualified such as my colleagues. Honestly, some of these comments are embarrassing."

      Perhaps I could direct your embarrassment to a more appropriate place by drawing your attention to this:

      "Ever since the Institute of Medicine released a report in 2000, entitled "To Err is Human," in which it reported that physici

      • by fbjon (692006)
        Holy statistic-twisting, batman!


        16000 people out of how many die from drugs, and 44000-98000 of how many die from physician error?

        Go back to school and stop flaming.

    • Honestly, some of these comments are embarrassing.

      I call BS! With a statement like that, you must be new here .

      I mean really. At the very least, I've yet to see a car analogy in this thread. Things are looking up perhaps.

      And, for the record, IAAMD (I am a doctor) and you're right. This seems like a solution in search of a problem. The only time where this might be useful is the very occasional emergent surgery where you don't have time to count before opening (a pretty rare event). Even then, the

    • by Yvanhoe (564877)

      Oh and Slashdot... please stop with the non-sense. Most of you are software or hardware nerds. You're not lawyers, doctors or surgeons. Leave the arm-chair medicine to someone more qualified such as my colleagues. Honestly, some of these comments are embarrassing.

      Comments made by competent people usually end up at +5 informative or insightful down here. Like yours. Communication between specialized fields is important, as a medical professional this must be obvious to you. I am strongly against the idea that no one must interest himself to stuff outside his own field. Even area as different as medicine and IT cross sometimes. From the whole "cell phone antennas give cancer" thing to the "another hospital published its patients data on internet by mistake", there ar

  • Remember, these are the guys who had an newborn "lifted" from their post-partum unit back in 2000.
  • Adding another set of steps to an already complex procedure... I'm sure that will solve the problem.
  • I can only hope that there exists a button to manually override the system and say "We know we extracted it, but the scanner does not recognize it any more". Otherwise the following procedure will be standard: Check in, Check out, insert into patient.

    IMHO always equip databases with the option to say "i dont know" or "i know" otherwise people will find funny devastating ways to abuse the system.

  • Happened to me too (Score:2, Interesting)

    by CranberryKing (776846)
    Not quite the doctors wristwatch joke. I had an infection occuring in my gum one time and went to the dentist, who said an old root canal had become infected. After the x-ray, they told me I had a piece of a "file" in my tooth. I was confused at first. Aparently, when I had the root canal done, the dentist was filing the inside of my tooth and the tip of the file got stuck and then (he) broke off. So of course, he filled in the tooth, leaving the file bit inside and without telling me. Apparently also this
  • What about Junior Mints finding their way into the patient from the observation area?
    • Actually, studies have shown that Embedded Junior Mints (EJMs, as they're known in the industry) actually speed recovery.

      Who's gonna turn down a Junior Mint? It's chocolate, it's peppermint-- it's *delicious*!
  • Poor solution (Score:2, Insightful)

    by LagFlag (691908)
    In our OR, sponges come in packs of 10. They are counted by the surgical scrub (a graduate of a 12 to 18 month technical program) and an RN (usually a college graduate) together. I have seen cases where there could absolutely be no lost sponge (i.e., small incision on an arm or leg), yet the sponge count is incorrect. This can result from either incorrectly counting the sponge at the beginning of surgery, or someone careless throwing out a sponge with a surgical towel or gown. Although I have seen surgeon
  • This is another example of why the medical system is so ridiculously expensive. Yes, it sucks that 1600 people a year get something left inside them. However, considering all of the surgeries that take place in the USA, statistically, this is darn near perfect already. It has to be close to a one in a million chance that you get something left inside you, and so, the question is, will the RFID improve the process enough to close that gap, and if so, how much does it cost everyone to have it everywhere al
  • Rope 'em up (Score:3, Funny)

    by flyingfsck (986395) on Sunday December 09, 2007 @05:24PM (#21634199)
    Why don't they just add a six foot piece of surgical string to all surgical tools? A patient with long strings dangling out after an op will be fairly obvious.

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