1. Technology adjuncts to preventing retained foreign objects.

2. 2

3. Is it possible to achieve and maintain zero retained foreign objects with manual and human systems alone?

4. 4 Problems with manual/human systems Drift Distraction Human error Not everything is counted At least 88% of retained sponges had a “correct count”

5. 5 Technical adjuncts Bar-coded sponges: augmented count Radio frequency (RF): detection of sponges Radio frequency (RF): augmented count + detection (RFID)

6. 6 Bar coded sponges Bar code on sponge Scan in/scan out Message when counts don’t match Mismatched counts must be reconciled manually If sponge not scanned in and not removed, it will not be detected Can keep a record of each sponge

7. 7 Radio frequency detection A small (size of a grain of rice) RF chip in each sponge Counting processes remain unchanged Wand the patient prior to closure; a signal indicates presence of a sponge

8. 8 An RF chip (size of a penny) in each sponge Scan in/scan out Message when counts don’t match Wand the patient prior to closure; a signal indicates presence of a sponge If sponge not scanned in and not removed, it will be detected by wanding Can keep a record of each sponge Radio frequency identification

9. 9 Low-tech adjuncts Hanging sponge clips Numbered sponges Other?

10. 10 Possible benefits of technology Reduce/eliminate retained sponges and related equipment Reduce throughput in the OR due to less time needed to “search” Earlier closure of the wound Fewer x-rays

11. 11 Possible unintended consequences of technology Introduce new sources of error/failure Systems depend on user to use them correctly Introduce a false sense of security Diversion of attention Inadvertent use of “incorrect” sponge Adding to the waste stream

12. 12 Evaluating and comparing the systems There will be no randomized, double-blind comparisons: even with manual systems, retained sponges occur in the order of 10 -3 (~1/8,500 cases) Bar coded sponges reduce the incidence by an order of magnitude to 10 -4 (~1/58,000 cases) RF is at least as effective as bar coding and may be more effective Reference: Regenbogen, S. Surgery 2009; 145:527-35

13. 13 Critical questions What is the likelihood that the system chosen will get you to zero retained sponges? What is the likelihood that the system will introduce new errors that will offset the gains? What is the impact on workflow? What usability issues does the system have? Is it intuitive? Does it require specialized training or technique? What does the system cost? What is the longevity of the system and investment: what if something better comes along next year?