U-M develops new system to reduce incidence of retained surgical instruments

It may sound like something from a TV medical drama, but the incidence of surgeons leaving something behind in the body is very real at hospitals across the country.

For decades, surgical teams have relied on counting -- and recounting -- the sponges, needles, blades, retractors, and other items used during operations.

But the University of Michigan Health System has created a new system using state-of-the-art technologies to insure that no foreign objects are left behind during surgery, reducing potentially serious medical errors.

"Having a foreign object left behind during surgery is something we consider a 'never event,' " says Ella Kazerooni, M.D., M.S., professor of radiology at the U-M and associate chair of clinical affairs at the U-M Health System. "It's something that should never happen.

"Unfortunately in complex cases, surgical cases that involve emergencies or in very large patients, items can be left behind in the body and we want to do everything we can to prevent that," she says.

Some of the methods put into practice at the U-M to prevent retained surgical objects:

Bar-coded sponges. Sponges are the most frequent item to be left behind after surgery, but with bar-coded sponges, computers help do the counting. Bar codes are scanned when sponges are used and scanned again when they're taken out of the body. If there's a count discrepancy, the surgeon knows to search the surgical field for something that may have been overlooked.

Electronic radiology orders. The U-M transitioned from a manual radiology order to an electronic order system to quickly call for help to locate retained objects. X-rays to find retained items are performed while the patient is still in the operating room.

"The practice of manually counting is a long-standing practice within the OR," says Shawn Murphy, R.N., nursing director of University of Michigan Health System operating rooms. "Surgical teams may count more than a hundred items in a single case."

The kinds of items include instruments used during procedures, needles for suturing or sponges used to pack the incision area open to improve the view of the surgical field.

But radiology can play a key role in prevention of retained surgical objects. X-rays can identify metal items, and also soft goods. The bar-coded sponges contain a radiopaque tag, allowing a radiologist to see it on an x-ray.

"The challenges of involving radiology in the operating room are mostly ones of communication and timing," Kazerooni says. "First, the surgical team needs to recognize that there may be a possible retained foreign object. Once they do, there needs to be good communication with the radiology department to get the technologist into the OR as quickly as possible. We don't want to delay the surgery or lengthen the anesthesia time unnecessarily."

Reducing the incidence of retained surgical instruments is a key patient safety goal of the U-M's Department of Surgery.

The U-M performs about 46,000 surgical cases a year, and conducts some of the most advanced heart, vascular, transplant and cancer surgeries in the country.

Operating rooms in the Health System's University Hospital, U-M Cardiovascular Center and C.S. Mott Children's Hospital are part of the initiative to prevent retained surgical items.

The system has helped: it's been more than a year since an event at the U-M, and intraoperative imaging continues to improve.

"The University of Michigan is leading the way in reducing retained foreign objects in the operating room," says Kazerooni. "It's a combination of using new technologies as well as culture change, teamwork and collaboration that's making it possible."