Bar Codes Keep Surgical Objects Outside Patients 269
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."
Also known as... (Score:5, Funny)
Tee hee.
Bet this guy blame this on the medical staff! (Score:2, Funny)
Re:Also known as... (Score:5, Funny)
A 39 cent solution (Score:5, Insightful)
Re:A 39 cent solution (Score:5, Informative)
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
Just helping to add some facts to this discussion!
Re:A 39 cent solution (Score:5, Interesting)
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.
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I should mention that everything that could possibly get lost inside a patient is radiopaque. That is, it'll show up on an x-ray. In the current system, in the extremely rare case that you can't find something, you can take a film to see where it is. So again, this doesn't really give you anything new except a higher price tag.
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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
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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)
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
Somehow I find this unlikely... (Score:2, Interesting)
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
Re:Somehow I find this unlikely... (Score:4, Informative)
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.
Surgeon accountability? (Score:3, Insightful)
Re:Surgeon accountability? (Score:5, Interesting)
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.
Re:Surgeon accountability? (Score:4, Interesting)
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.
Re:Surgeon accountability? (Score:5, Insightful)
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.
Re:Surgeon accountability? (Score:4, Interesting)
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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.
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...said the person who must have never had surgery ;)
Nothing major, thank God, just a broken thumb, a broken jaw, and a broken nose. Nothing life threatening.
I don't think you can dismiss surgery as somehow being of lesser impact than major engineering feats, simply for the fact that surgery happens a lot more frequently than building a bridge.
I'm saying that one fuckup in surgery is less dangerous than one fuckup in engineering. Hell, one hundrend fuckups is less dangerous. But don't get me wrong, I respect and even admire surgeons. I don't underestimate their work at all.
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In any case, engineers have had automated tools to help prevent the fuckups that lead to catastrophe for years. Nice to see the surgeons getting some backup as well.
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That's your belief. That's not a fact. There is a difference.
It seems like a case of using advanced technology to solve an ongoing problem.
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"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".
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Good surgery is not a one-man operation, it's a team. And teams can lose track of small objects.
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i'd much rather the surgeon be worrying about keeping me alive while under the knife, not worrying about how many sponges he has used.
I agree completely. I would absolutely want the surgeon focused on keeping me alive = but I certainly wouldn't complain if they had an intern stand around and keep track of things like that. Good learning experience (getting to watch all sorts of surgeries), they get to do something that could potentially save my life, and I don't have to worry about them being in a position to make a critical mistake. Another pair of eyes watching for simple mixups seems like a winner to me.
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Well, it's not like they're worried about the number of sponges used so they can charge your insurance more. The problem is that when a sponge is left in the body, it IS a life threatening situation. If you get sewn up with one in you, it becomes a site for serious infections that can lead pretty quickly to death.
It's also not so hard to imagine one being left in there beca
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It's also not so hard to imagine one being left in there because you've got this lumpy bloody thing in a body full of lumpy bloody things.
Okay, I want the surgeon to be freed up for the tasks that require a surgeon while nurses, surgical techs, and/or interns count sponges. And I don't want the gory details on how a sponge can hide, I'll take it on faith that it's very difficult to track down. But I expect him to have a slightly better grasp of anatomy than "lumpy blood thing".
"Nurse, see that lumpy bl
hah (Score:5, Funny)
(tagging beta)
RFID? (Score:2)
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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
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I don't think your concerns are valid.
If they scan the sponge on the way in, they'll know the RFID chip is working. If it's working at that point, it's highly unlikely it will stop working during the surgery.
Cost isn't really an issue either. In large quantities RFID chips can cost as little as a $0.10. Even if a surgery uses 200 sponges, that's only $20 extra. I don't know what that translates to in medical pricing, but I'd pay an extra $20 to not have stuff left inside me.
I'm also pretty sur
We had (or have?) this problem in Mexico... (Score:2, Interesting)
RFID (Score:5, Informative)
Barcodes?? (Score:2)
I'd hate to be the one trying to scan barcodes from blood-soaked sponges. Isn't some equipment too small to barcode?
Why not RFID? (Score:2)
Or they could try using Checklist instead. (Score:2, Informative)
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And people can mis-count.
Bar Code is Out; RFID is In (Score:2)
That way, one could even find out the details of the items left out, if any.
I'm cringing... (Score:5, Informative)
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.
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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)
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
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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.
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"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
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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.
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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
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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
LUMC is very anal about counting things nowadays. (Score:2)
Great... (Score:2)
I hope they have a reasonable manual override. (Score:2)
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)
Yeah, but... (Score:2)
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Who's gonna turn down a Junior Mint? It's chocolate, it's peppermint-- it's *delicious*!
Poor solution (Score:2, Insightful)
A Total Waste of Money (Score:2)
Rope 'em up (Score:3, Funny)
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Re:Ya gotta wonder.. (Score:5, Insightful)
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The doctor doesn't bother (Score:2)
Re:Ya gotta wonder.. (Score:5, Insightful)
So until you have a medical degree and the years of on the job experience that it takes to even set foot in a surgery, you don't get to call anyone an idiot that does.
Doing otherwise makes you look like a typical fat,lazy, IGNORANT armchair skeptic who can't even be bothered to use the slightest bit of brain power their pathetic brain is capable of mustering.
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Doing otherwise makes you look like a typical fat,lazy, IGNORANT armchair skeptic who can't even be bothered to use the slightest bit of brain power their pathetic brain is capable of mustering.
But there's an operation he can have to fix that, right?
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Or, I don't know, maybe instead of relying on unskilled labor they could come up with an automated solution to an apparently simple yet safety-critical task? Which is the sort of thing that machines are better at anyway? I mean would you rather trust yo
Just another statistic (Score:2, Insightful)
If they get the right paperwork - they can operate on the wrong side. My mother is a nurse (30+ years), and her advice is to make sure you permanent-marker the correct area before they get you ready for your surgery.
As for leaving stuff in your sewn up body ~ it happened to my grandmother 4 times.
I guess you have underachievers, alcoholics, and newbies in every profession.
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Re:Ya gotta wonder.. (Score:4, Insightful)
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I hope you are being sarcastic. If you weren't, and if your job in any way impacts public safety, please resign immediately.
Re:Anything. (Score:5, Insightful)
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Re:Anything. (Score:4, Funny)
Re:Anything. (Score:4, Funny)
"Oh my god. Do you call yourself a surgeon!?"
"Well, no, Mrs. Smith, I'm the IT trainee assigned to the OR. But - I AM a certified Microsoft System Engineer."
Re:Anything. (Score:4, Insightful)
Re:Anything. (Score:4, Funny)
Re:Anything. (Score:4, Informative)
Instruments make up the bulk of the "things" used in a procedure. The emerging tech for tracking those is called dot peen marking. It's mostly designed to help the Central Supply staff (who clean and sterilize equipment) keep their sets together and track where things are in the overall process.
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Something had to sterilize and pack them the first time, right?
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Well, to be fair, the person who wrote the article was George H. W. Bush. (1992) [pqarchiver.com]
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Maybe if it used RFID and a few other buzzwords then yeah but not a barcode.
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Re:High Tech Barcode Scanner? (Score:4, Insightful)
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Re:RFID? (Score:4, Insightful)
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Don't the sponges biodegrade inside the body? Do they need to encapusalete?
Do you have any issues with the RFID tags being ruined by X-ray equipment? Or being ruined by MRI's done on patients who had to be pulled straight from surgery to the MRI chamber for whatever reason?
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Talk about your exhorbitant markup... How many businesses outside of medecine get a 170% markup on ther products to end consumers?
Phone. Cable. Military contractors. Things bought with your Tax money. Any domestic product that can only compete against the equivalent foreign import via government subsidies and trade tariffs.
Besides, I imagine that the 170% markup has to cover thorough training and medical insurance. If you make a single mistake while using the wand and miss a RFID for any reason,
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Given the quality of country hospitals in Australia, we had
this guy [wikipedia.org] and others like him, I can't see this being a high priority here. We also have less malpractice lawsuits, so that may be the difference.
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3 minutes per hour spent counting is a serious cost.
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But your close. Each sponge has a radioopaque (visible under x ray) stripe on it. If your count is wrong, you get an xray.