Monday, May 21, 2012

The Vexing Problem Of Retained Instruments After Surgery

A medical technology company is developing radio frequency identification technology to assist surgical teams in detecting surgical sponges. At first blush this is not breaking news, but it illustrates a much bigger reality about our medical system.

For years, surgical items like sponges, towels, clamps, foreceps, gauze, and countless other items have been left in patients. Although estimates of this occuring varies, the larger point is obvious: despite all the best hospital protocols, rules, and policies requiring accurate counting of surgical instruments, "stuff" left inside patients' bodies continues to happen, as evidenced by continuing efforts to develop technology to overcome human error. But as safety technology is evolving, the obvious question is: WHY does this continue to happen?

After all, aren't hospitals accredited by organizations who scrutinze their patient safety? Of course. And don't they grant privileges to only the best surgeons who are vetted by the hospital credentialing committees? Presumeably. So how do retained surgical objects continue to happen in "Groundhog Day" fashion and fuel the ongoing need for new technological breakthroughs?

Simple. The practice of medicine is a volume business. Time is money, and patients are frequently a cog in a wheel of a continuing production schedule where medical decisions are often influenced by issues extraneous to what is best for the patient---like having the time to count objects. This is no great revelation to patients. As an analogy, just ask anyone who experienced a loved one discharged too early because of "reimbursement issues," despite what they were told by the medical team.  When something as simple as counting what goes in and what leaves the body is subject to repeated error, it is symptomatic of a larger problem.

We hear over and over that we have the best medical delivery system in the world and this is largely true. But leaving anything behind is 100% preventable and should never happen--no exceptions. In a time where politicians and the medical profession decries medical malpractice lawsuits, it is time to recognize that cases involving retained surgical objects prove an unassailable truth: a major cause of malpractice lawsuits is malpractice. And the easiest way to prevent these lawsuits is to decrease malpractice.

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