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Bar Codes Keep Surgical Objects Outside Patients

Zonk posted more than 6 years ago | from the that's-just-where-I-like-them dept.

Technology 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."

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269 comments

Also known as... (5, Funny)

The Hobo (783784) | more than 6 years ago | (#21629307)

Reference counting. Insert obvious garbage collection joke here.

Tee hee.

Death by scrubby-sponge... (2, Funny)

six6 (765050) | more than 6 years ago | (#21629567)

There's an AJAX joke here somewhere...

High Tech Barcode Scanner? (1)

greatgreygreengreasy (706454) | more than 6 years ago | (#21629309)

I'm guessing the scanner they use is fairly sophisticated, because bar code scanners aren't all that high-tech anymore, are they?

Re:High Tech Barcode Scanner? (2, Interesting)

User 956 (568564) | more than 6 years ago | (#21629389)

bar code scanners aren't all that high-tech anymore, are they?

Well, to be fair, the person who wrote the article was George H. W. Bush. (1992) [pqarchiver.com]

Re:High Tech Barcode Scanner? (1)

cheater512 (783349) | more than 6 years ago | (#21629427)

Yeah I wouldnt call it high tech.

Maybe if it used RFID and a few other buzzwords then yeah but not a barcode.

Re:High Tech Barcode Scanner? (2, Funny)

roguetrick (1147853) | more than 6 years ago | (#21629447)

Hey, whenever I walk into the local Weis grocery store, I feel like I'm in a sea of technology. That or rotten produce, I can't tell the difference.

Re:High Tech Barcode Scanner? (3, Insightful)

deniable (76198) | more than 6 years ago | (#21629625)

How do you scan a bar-code on a sponge designed to soak up blood and yuck? That might be the high-tech part of the scanner.

Re:High Tech Barcode Scanner? (2, Insightful)

$random_var (919061) | more than 6 years ago | (#21629631)

Bar codes aren't high-tech, but applying them to a number of discrete objects in a highly variable environment with a lot of occlusions and weird angles to solve a very relevant medical problem IS novel and definitely worthwhile.

Anything. (1)

Merls the Sneaky (1031058) | more than 6 years ago | (#21629315)

Anything that helps doctors and nurses to do their job properly is fine by me. Barcoding the items is a damn fine idea. Just don't know how it hadn't been implemented sooner.

Re:Anything. (5, Insightful)

Edward Kmett (123105) | more than 6 years ago | (#21629347)

I have enough trouble getting these things to scan under ideal conditions at the grocery store let alone after being pulled used and bloodied from the body of a patient.

Re:Anything. (2, Insightful)

DigitAl56K (805623) | more than 6 years ago | (#21629479)

let alone after being pulled used and bloodied from the body of a patient. .. in the middle of a critical surgery ..

Re:Anything. (3, Funny)

deniable (76198) | more than 6 years ago | (#21629633)

Price check in OR 3. Price check in OR 3.

Re:Anything. (3, Insightful)

chuckymonkey (1059244) | more than 6 years ago | (#21629515)

I think that an RFID would be great too. Have one on each surgical instrument and after everything is complete and you're ready so sew them back together you run a quick scan over the person's body to check for any RFID. That might be over generalized since I'm not a doctor, but I'm sure that everyone here gets the idea.

Re:Anything. (1, Interesting)

Anonymous Coward | more than 6 years ago | (#21629525)

Actually, I saw this on the discovery channel about five or six years ago. Back then, they were deploying this in major cities in Europe and Asia. Note how the article says Loyola is the first in *the midwest* to deploy this. Way to go, America. Maybe if we spent less money on needless invasions, we'd have better health care (and education and fusion and a moon base and flying cars and pet dinosaurs and global non-theism AKA world peace and disco would come back into fashion).

Re:Anything. (1)

CSMatt (1175471) | more than 6 years ago | (#21629563)

and disco would come back into fashion
And why would we want that to happen?

Re:Anything. (1, Funny)

Anonymous Coward | more than 6 years ago | (#21629551)

Anything that helps doctors and nurses to do their job properly is fine by me. Barcoding the items is a damn fine idea. Just don't know how it hadn't been implemented sooner.
Don't know. But the idea does sound strangely patentable in the US which could be a reason.

Re:Anything. (3, Insightful)

Anonymous Coward | more than 6 years ago | (#21629569)

Meh. Previously, they were supposed to keep count of how many they inserted. If they forget to scan one on the way in, same problem. What they ought to do is open packs of 10 at a time. If they don't have 10 or 20 (clean and used) when they're done, then they know they have a problem. They could recycle the unused ones by sending them to some orderlies to repack them into 10s, and verify it by weight. $300 for a good electronic balance, and they have a system that will actually work. Sometimes low-tech is the appropriate solution.

Re:Anything. (0)

Anonymous Coward | more than 6 years ago | (#21629639)

commenting to undo moderation.

Re:Anything. (1)

seifried (12921) | more than 6 years ago | (#21629717)

As a rule you don't generally repackage sterile sponges... hint: sterile.

Re:Anything. (1)

evought (709897) | more than 6 years ago | (#21629803)

As a rule you don't generally repackage sterile sponges... hint: sterile.
Hint: autoclave.

Something had to sterilize and pack them the first time, right?

Ya gotta wonder.. (-1, Flamebait)

QuantumG (50515) | more than 6 years ago | (#21629321)

what kind of idiots you are hiring to work in surgery who can't even count.

Re:Ya gotta wonder.. (1)

satoshi1 (794000) | more than 6 years ago | (#21629333)

I bet that the amount of sponges in any given area is fairly trivial compared to the life of the patient that is on the line.

Re:Ya gotta wonder.. (4, Insightful)

Rakishi (759894) | more than 6 years ago | (#21629343)

I'd prefer a doctor operating one me to pay attention to the patient not pause to remember if this was the 16th sponge he took out or if the 16th was the one he took out 10 minutes ago.

Re:Ya gotta wonder.. (1)

JackMeyhoff (1070484) | more than 6 years ago | (#21629837)

He shouldnt have that overhead if it is automated :) Hint: Barcodes and his assistants should track the equipment, thats why he ASKS his assistants for equipment

Re:Ya gotta wonder.. (2, Insightful)

zmotula (663798) | more than 6 years ago | (#21629887)

All the doctor would have to do is to equip his assistant with an abacus. Insert a sponge, move a bead right. Remove a sponge, move a bead left. Multiple rows for tracking multiple items, each row labeled. No barcodes, no lasers, no expensive machines.

Re:Ya gotta wonder.. (5, Insightful)

timmarhy (659436) | more than 6 years ago | (#21629345)

There's 100's of objects involved in some surgeries, some procedures taking many hours with multiple specialists having to come in and out to work on their area of expertise.

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.

Re:Ya gotta wonder.. (1, Funny)

QuantumG (50515) | more than 6 years ago | (#21629583)

So you're saying they can't count to a hundred. Well then, that's different.

Just another statistic (2, Insightful)

Smordnys s'regrepsA (1160895) | more than 6 years ago | (#21629365)

Hell, sometimes they just get the wrong patient/records (take your pick).

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.

Re:Just another statistic (2, Insightful)

PieSquared (867490) | more than 6 years ago | (#21629393)

Probably a better idea to permanent-marker the *incorrect* area (or both). Because there's a chance they don't even look at the mirror of where they plan to operate.

Re:Just another statistic (2, Funny)

Dorceon (928997) | more than 6 years ago | (#21629473)

Or do both, like in the House episode where he wrote "Not this leg" on the good leg and "Not this leg either" on the bad one.

Re:Ya gotta wonder.. (3, Insightful)

wizardforce (1005805) | more than 6 years ago | (#21629367)

they're too busy doing surgery to worry about counting the number of sponges. but really, think of the number of surgeries that are done every year vs how many actually have this sort of thing happen. surgeons could probably go through hundreds of surgeries without anything remaining in a patient that wasn't supposed to be there and there's always that one time... anything that reduces the probability of harm to those going through surgery is a good thing, it's not perfect but it's improving and that's always a good sign,

Re:Ya gotta wonder.. (2, Insightful)

Antique Geekmeister (740220) | more than 6 years ago | (#21629897)

The idea is to reduce the manpower needed to track the sponges. In a messy abdominal surgery, or open heart, you'll go through dozens. Being able to say "it's spong 12345, that was from the pack we opened last" is amazingly helpful to finding the missing sponge, and it's a lot less labor intensive than counting and double checking when the double counting is liable to introduce its own miscounts either way.

Re:Ya gotta wonder.. (3, Insightful)

YetAnotherLogin (534226) | more than 6 years ago | (#21629539)

If you truly think that, then you should probably read this eye-opening article: The Checklist [newyorker.com] .

Re:Ya gotta wonder.. (2, Insightful)

s20451 (410424) | more than 6 years ago | (#21629603)

So you believe something mission critical should rely on single redundancy, since only stupid people make mistakes?

I hope you are being sarcastic. If you weren't, and if your job in any way impacts public safety, please resign immediately.

Somehow I find this unlikely... (2, Interesting)

Z80xxc! (1111479) | more than 6 years ago | (#21629331)

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 plan may not be 100% effective, and I sure wouldn't want to be left in the hospital to die because one sponge fell under the bed.

Re:Somehow I find this unlikely... (1)

timmarhy (659436) | more than 6 years ago | (#21629357)

no, operating theaters don't work like that. no just walks out with a blood soaked sponge.

they are also very cleanly laid out, so if you can't find something, chances are you left it inside.

Re:Somehow I find this unlikely... (1)

Z80xxc! (1111479) | more than 6 years ago | (#21629383)

I guess it's time to make a new internet abbreviation:
IANAS
(I am not a surgeon.)

Really. I'm not. I was just speculating; I have never been operated on or seen someone operated on, so I guess I wouldn't really know. Thank you for clarifying.

Re:Somehow I find this unlikely... (-1, Troll)

Anonymous Coward | more than 6 years ago | (#21629725)

Go back to digg, you're too stupid for Slashdot.

Re:Somehow I find this unlikely... (3, Informative)

ContractualObligatio (850987) | more than 6 years ago | (#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.

Surgeon accountability? (3, Insightful)

psued0ch (1200431) | more than 6 years ago | (#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.

Re:Surgeon accountability? (1)

timmarhy (659436) | more than 6 years ago | (#21629377)

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.

with ever more complex operations happening, there is hardly anything "basic" about a lot of what happens.

try watching one of those medical shows and you'll see about 1% of whats involved. to qualify my comments i used to work in the medical field in an IT capacity.

Re:Surgeon accountability? (1)

Palpitations (1092597) | more than 6 years ago | (#21629685)

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.

Re:Surgeon accountability? (2, Insightful)

hazem (472289) | more than 6 years ago | (#21629729)

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.

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 because you've got this lumpy bloody thing in a body full of lumpy bloody things.

So yes, you want the surgeon focusing on your procedure and keeping you alive while under the knife - but you don't want him leaving things behind that will cause you to die AFTER you're under the knife.

Re:Surgeon accountability? (4, Interesting)

Elrond, Duke of URL (2657) | more than 6 years ago | (#21629421)

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? (1)

timmarhy (659436) | more than 6 years ago | (#21629483)

good on you for being sensible about it. far too much litigation happens over things that simply aren't anyones fault.

as you well know there's no sure things once you start opening the body up, yet people seem to think they have a "right" to a trouble free operation.

Re:Surgeon accountability? (3, Interesting)

Detritus (11846) | more than 6 years ago | (#21629775)

Sometimes it's needed. If a physician doesn't keep up with the advances in his field, he can unnecessarily kill or injure his patients. I was reminded of this while watching an old biographical movie on the life of Louis Pasteur. It portrayed the old "blood and guts, soap is for wusses" school of medicine.

Re:Surgeon accountability? (3, Interesting)

truesaer (135079) | more than 6 years ago | (#21629581)

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.

Re:Surgeon accountability? (4, Insightful)

Puff of Logic (895805) | more than 6 years ago | (#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.

Re:Surgeon accountability? (1)

dotancohen (1015143) | more than 6 years ago | (#21629561)

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.

Re:Surgeon accountability? (1)

bretticus (898739) | more than 6 years ago | (#21629621)

I graduated with a degree in engineering (close to 4.0), and I'm now in med school. I would not advise going to med school as an "easy" way out of anything. It's ridiculous. I can't even describe it to you. Fucking ridiculous.

Re:Surgeon accountability? (1)

baboo_jackal (1021741) | more than 6 years ago | (#21629705)

That said, surgery is in my opinion a minor event.

...said the person who must have never had surgery ;)

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.

Ah, but how many bridges or whatever does one engineer contribute significantly enough where his or her fuckup would cause a catastrohpic failure? Maybe one or two in a year? Plus, I'm guessing you don't get to have that significant of an impact on a project until you're a seasoned engineer of some sort, right? I'm guessing that not even until you're well into your engineering career do you get to be the engineer equivalent of a dev lead.

And how many patients does a surgeon operate on where his or her fuckup would cause a catastrophic failure? Um, I dunno, say four to eight in a day (call it six), maybe? So that's, what, 6 * 50 = 300 people a year, give or take?

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.

Re:Surgeon accountability? (1)

dotancohen (1015143) | more than 6 years ago | (#21629845)

...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.

Re:Surgeon accountability? (1)

DerekLyons (302214) | more than 6 years ago | (#21629565)

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.

Re:Surgeon accountability? (1)

Class Act Dynamo (802223) | more than 6 years ago | (#21629571)

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 track of equipment; however, don't trivialize how difficult that can be under the conditions of a surgical procedure. It is a mess in there.

Re:Surgeon accountability? (1)

bm_luethke (253362) | more than 6 years ago | (#21629695)

In nearly all major surgeries you will have a fairly large amount (in the two digits) of specialists work on you. It is assumed by the other doctors that each specialist knows what they are doing and doctors generally do not interfere with others. Given that there are thousands of surgeries per year it is not surprising that something get left behind.

Now, I agree we can all point to cases where the surgeon closing should have known better (or at least asked), Large sponges, clamps, and many other large obvious objects shouldn't get closed up in you. However I know of several people who had stuff left in them on purpose for short periods of time, those items needed for the body to recover.

Then there are small items, my father had some of his heart monitor wires left in well after they should have been removed - it wasn't until all the doctors signed off on his release that the lest one in line went "Uh oh - this is going to painful". Each one in line thought one of the others had needed and could make up all sorts of reasons why it could be needed.

IMO anything that causes some type of flag to be raised at the end "This is listed as need to remove" is a good thing. Given the number of surgeons/specialists along with the number of surgeries they do even a .01% chance will result in some left over. I highly suspect that the vast majority of humans in the word would be ecstatic with that success rate (in fact, that success rate is considered impossible) let alone 5 zeroes. Yet doctors are expected to truly have a 0% failure rate.

Electronic devices are *simple* compared to surgeries and five nines are considered the holy grail, let alone *infinite nines* (and yes, some electronic devices are life critical - see medical devices). Five nines is GREAT even for simple devices. Of course negligence and incompetence are one thing and should be punished (especially in life critical applications), reasonable failure is another.

Re:Surgeon accountability? (1)

ContractualObligatio (850987) | more than 6 years ago | (#21629769)

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".

Re:Surgeon accountability? (1)

Antique Geekmeister (740220) | more than 6 years ago | (#21629813)

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.

First Shot! (-1, Troll)

Anonymous Coward | more than 6 years ago | (#21629341)

LAWLS at Omaha.

RFID? (-1, Redundant)

Anonymous Coward | more than 6 years ago | (#21629351)

I wonder if they couldn't use some sort of RFID...it would prevent the need for scanning. And, you could tell if there was something inside the patient by just scanning the patient.

Of course, the doctors may not want to let you know if they left something inside you. Malpractice anyone?

Re:RFID? (1)

phillips321 (955784) | more than 6 years ago | (#21629405)

i thort this was a good idea, why mod it -1?

Re:RFID? (4, Insightful)

Bentov (993323) | more than 6 years ago | (#21629409)

I work at a Level 1 trauma center and we do indeed use RFID sponges. Currently we are only using them on a trial basis for trauma surgeries, but I would guess that once the cost drops some, we will infact use them for all surgeries. The RFID wands cost about $50.($135 patient cost). Sponges are bad, but the body will encapsulate them after awhile....retractors on the other hand....I don't know how the hell you leave something 1 foot long and 1.5 inches wide in someone...that boggles the mind. As someone said earlier though, when you have multiple surgeons, multiple residents, multiple scrub techs and circulators, things will get missed. Ofcourse the worst thing is what people call it when something is left in a patient or something goes wrong, a "surgical misadventure" that is just wrong.

Re:RFID? (3, Interesting)

Titoxd (1116095) | more than 6 years ago | (#21629627)

Does the RF cause any problems with other medical equipment? Last time I was at a hospital (a while ago, thankfully), there was a big sign saying, "No cell phones" in order to avoid interference, so I wonder how you deal with that problem.

hah (4, Funny)

flonker (526111) | more than 6 years ago | (#21629379)

Well, I laughed at the bottom of the post where it said

(tagging beta)

RFID? (1)

Capt'n Hector (650760) | more than 6 years ago | (#21629391)

Wouldn't RFID be more appropriate than bar codes in this situation?

Re:RFID? (1)

GwaihirBW (1155487) | more than 6 years ago | (#21629425)

No. RFID chips can break . . . better to have something that you can't come to rely on being able to track remotely. More importantly, though, adding barcodes to sponges and assorted other inserted instruments is easy and inexpensive, adding rfid chips is not. Especially something like sponges and other things that should not have hard bits in, not to mention that it's a bit wasteful for single-use items that you may use a hundred or more of in a single surgery.

Re:RFID? (1)

GwaihirBW (1155487) | more than 6 years ago | (#21629445)

*sigh* I stand very quickly corrected:
http://slashdot.org/comments.pl?sid=383979&cid=21629409 [slashdot.org]
(Post in thread just above)

Still, I like barcodes better because of the breakage possibility - scan barcodes going in == guaranteed count, don't use a failed scan. Scan barcodes coming out - if one fails, manually count, easy enough. RFID has the advantage of catching error where something got used without going through the counter, though . . . . mebbe a combo is a good idea. Although in that case you may have slightly higher compliance issues because of the greater ease of one system . . . I'm too pessimistic to design medical devices, apparently.

Re:RFID? (1)

jlarocco (851450) | more than 6 years ago | (#21629875)

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 sure "having hard bits" isn't much of a problem either. As long as it soaks up what it needs to soak up, who cares? An RFID chip isn't very large, and it'd probably be embedded in the middle of the sponge anyway.

Re:RFID? (0)

Anonymous Coward | more than 6 years ago | (#21629481)

Much better, RFID in this field exists for years. RFID companies have long seen this as one of their early markets.
Just an example: http://www.rfidjournal.com/article/articleview/3572/1/1/ [rfidjournal.com]
But GIYF.

Re:RFID? (0)

Anonymous Coward | more than 6 years ago | (#21629619)

Just an alarm when they leave the hospital (on their way to the morgue)? It's much cooler to see all those barcodes in the X-ray.

Re:RFID? (1)

Antique Geekmeister (740220) | more than 6 years ago | (#21629847)

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 during surgery.

We had (or have?) this problem in Mexico... (1, Interesting)

Spy der Mann (805235) | more than 6 years ago | (#21629435)

in state hospitals. But not just with sponges. Also with forceps and other surgical instruments :-S

RFID (5, Informative)

RandomLinguist (712026) | more than 6 years ago | (#21629455)

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.

Barcodes?? (1)

DigitAl56K (805623) | more than 6 years ago | (#21629465)

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?

Why not RFID? (1)

Masa (74401) | more than 6 years ago | (#21629471)

RFID has already been suggested (here is the old Slashdot story [slashdot.org] ) and sounds much more convenient to use.

Re:Why not RFID? (1)

JK_the_Slacker (1175625) | more than 6 years ago | (#21629559)

I'll get right on slapping RFID tags in surgical sponges.

Hey, while we're at it, let's stick some in lunch meat, so we can keep track of who's eating what. And then we can put them in cans of soda. And diapers. Bottles of shampoo? RFID everywhere! Let's weave them in the fiber of our carpets! Let's put them in matchsticks!

Re:Why not RFID? (1)

FJR1300 Rider (888176) | more than 6 years ago | (#21629733)

RFID in surgical sponges already exists. Google for "ClearCount RFID sponge" [google.com] , and "Siemens RFID sponge" [google.com] . The ClearCount ones have already had FDA approval.

Or they could try using Checklist instead. (2, Informative)

gijoel (628142) | more than 6 years ago | (#21629507)

Alas doctors would rather a high tech approach rather than just a good old fashioned checklist of procedures [newyorker.com]

Re:Or they could try using Checklist instead. (1)

Chas (5144) | more than 6 years ago | (#21629553)

Again, with dozens (or hundreds) of pieces of equipment during a surgery, that's not always feasible.

And people can mis-count.

Bar Code is Out; RFID is In (1)

heytal (173090) | more than 6 years ago | (#21629509)

Why not use RFID ?
That way, one could even find out the details of the items left out, if any.

I'm cringing... (5, Informative)

Anonymous Coward | more than 6 years ago | (#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:I'm cringing... (1)

clayne (1006589) | more than 6 years ago | (#21629529)

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.
Then put your money where your mouth is and post with your slashdot ecock-ID.

Re:I'm cringing... (0)

Anonymous Coward | more than 6 years ago | (#21629681)

Yep. As they say: "Pix or it didn't happen."

Re:I'm cringing... (3, Funny)

truesaer (135079) | more than 6 years ago | (#21629595)

Well you've certainly picked up the legendary surgeon asshole-ego in medical school. Well done!

Re:I'm cringing... (2, Insightful)

Anonymous Coward | more than 6 years ago | (#21629715)

He may have an ego, but nothing he has said is wrong.

Re:I'm cringing... (1)

clayne (1006589) | more than 6 years ago | (#21629721)

Your sock has a hole in it.

Say the barcode becomes damaged (1)

yoshi2.0 (1199185) | more than 6 years ago | (#21629527)

If it ends up unreadable then what? They can't finish the surgery till they're all accounted for.

Re:Say the barcode becomes damaged (1)

clayne (1006589) | more than 6 years ago | (#21629543)

I'd say it's pretty safe bet they'll have a manual override mode - complete with associated paperwork and required signatures. I'm sure surgeons are just loving it.

BMW (0)

Anonymous Coward | more than 6 years ago | (#21629531)

they need to make it so my car won't leave the driveway if there are still two wrenches and an old control arm setting in the engine bay

Re:BMW (1)

clayne (1006589) | more than 6 years ago | (#21629663)

Or ratchet wedged on the intake plenum, you know the drill. :)

LUMC is very anal about counting things nowadays. (1)

Chas (5144) | more than 6 years ago | (#21629541)

Remember, these are the guys who had an newborn "lifted" from their post-partum unit back in 2000.

How does this work? (0)

Anonymous Coward | more than 6 years ago | (#21629589)

When sponges come out as blood-soak wads, how are you going to scan them? If one is left in the body, you still have to find it. I think this is definitely a case where RFID is better because it solves both problems.

The only thing barcodes can do is give you a good count at the start of the case. You scan each package of sponges you open (usually a few in each package), and you know the count is correct. Scanning the sponges as they come out is just not going to be feasible. I can't imagine any nurse wanting to have that job.

dom

Cost? (1)

Thanatos69 (993924) | more than 6 years ago | (#21629613)

Ummm, is anyone else wondering how much this cost? I have an idea that costs nothing, it's a bit archaic but why don't they just count the damn sponges and equipment before and after the procedure.

Re:Cost? (1)

deniable (76198) | more than 6 years ago | (#21629673)

This is to offset the costs of law-suits and other payouts. It's more for QA than patient care. Making sure you didn't leave anything behind is one thing, being able to prove it is another. They then need to not only label the sponges, but all of the tools.


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.

Re:Cost? (1)

Antique Geekmeister (740220) | more than 6 years ago | (#21629883)

Because it doesn't "cost nothing". Surgical staff, and the time in the OR, is hideously expensive. Double-checking and hunting for lost sponges when you've gotten a wadded up sticky, clotted mass from swishing out someone's lacerated colon is difficult and nasty and chews through expensive time. Holding up the theater because some new, rattled surgical intern or nurse in training lost track of sponges is worse.

3 minutes per hour spent counting is a serious cost.

Great... (1)

Zadaz (950521) | more than 6 years ago | (#21629651)

Adding another set of steps to an already complex procedure... I'm sure that will solve the problem.

String (1)

smaugy (50134) | more than 6 years ago | (#21629655)

IANASurgeon, but...... couldn't they just attach string to the sponges? Or would the strings get in the way? String hanging outside patient = sponge still inside...

I hope they have a reasonable manual override. (1)

drolli (522659) | more than 6 years ago | (#21629661)

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.

In Australian hospitals .... (1)

snoggeramus (945056) | more than 6 years ago | (#21629793)

Things such as gauze and sponges have a marking line printed on them which will show up on an x-ray. After an operation, a post-op x-ray is taken to ensure that nothing has been left behind. Really helpful in court when you've been accused of negligence.

An experence (0)

Anonymous Coward | more than 6 years ago | (#21629815)

This puts me in mind of an experience I had 4+ years ago. I had some minor surgery on my ear at a hospital in Michigan. It was a local anesthesia job because of the small area undergoing surgery and because it was on my head I was covered in whatever those blankets are called.

So to sum up the situation , I was awake with my face under a blancke for about three hours that afternoon. I learned two things about doctors that day. 1) They talk about sports, ect. while working just like everone else and 2) The worst thing you can hear while someone is performing surgery on you is "Where did that needle go?" followed by some nurses NEVER saying "oh, here it is."

If something like that can happen when highly trained professionals work on an area of a single ear then I am all for this tech.
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