What happens when an object is unexpectedly left inside a patient after surgery? In some cases patients suffer no adverse effects, in others life-threatening complications can develop. In a effort to avoid this problem and enhance patient safety, various items used during surgery are counted before and after a procedure. While it seems that process should solve the problem, statistics prove that instruments, sponges, needles, and even towels are accidentally left behind more often than patients might imagine.
Hospital risk management is always concerned about the potential of retained foreign bodies after surgery. Both from a patient safety perspective and from a financial liability perspective. Even more so now that objects unintentionally left in a patient after a surgical procedure will cause a decrease in reimbursement.
To those of us who don’t work in an OR setting, it might seem that the nurses charged with ensuring correct counts simply aren’t paying attention when things get left behind. Like most complications in healthcare, it’s not such a simple equation.
Surgeries can be long; nurses and other personnel may come in and out of the room. Interruptions while counting are the norm rather than the exception. Many surgical items come in packages. If the package says 10, a count of 10 goes on the record. What if an 11th item was accidentally included during packaging, or only 9? Needles can easily be dropped. Did it fall on the floor, into the trash, or into the patient? The search ensues in a room crowded with people, equipment, and bloody objects. If the object can’t be located X-rays may need to be taken and read. Sometimes retained foreign bodies show up plainly, sometimes not.
In the meantime, precious minutes tick by for both the patient and the OR team. Add to that the fact that operating room time is expensive and often in short supply. The pressure can be intense to finish and move out of the room so that it can be cleaned for the next patient.
The root of the problem however, is often communication. Surgeons and nurses are supposed to communicate freely during a procedure, after all they’re a team, right? What often happens instead is eloquently described in a column in Maggie Mahar’s blog Health Beat. A husband describes his OR observations during his wife’s C-section. It is a disturbing and disheartening account. Disheartening because the issues described are deeply ingrained into the culture of many healthcare organizations.
As with most cultural shifts, change will come about slowly, one doctor, one nurse, one administrator at a time.