Retained surgical sponges are a prevalent and often costly error, with the average malpractice lawsuit totaling $600,000.1 Due to the scope of the problem and its costly repercussions, Stryker decided to bring awareness to the issue and interviewed hundreds of nursing leaders, risk managers, surgeons and other healthcare personnel to understand the problem and work to address it going forward.
"Our due diligence focused heavily on the 'Voice of the Customer' process – asking questions and listening intently to what they had to say. We heard from many providers and hospitals that Stryker is a leader in healthcare," says Nate Miersma, director at Stryker SurgiCount, a safety sponge system company Stryker acquired last year. "Providers told us, we want Stryker to identify solutions to address our patient safety challenges and convince us to implement them by making a compelling argument. This is how we became interested in the retained sponge space."
Retained surgical sponges account for 69 percent of all reported retained surgical items2, a large portion of these instances are not reported. However, while many in the medical community went into healthcare to help patients, they are often not aware of such incidents' prevalence and often fall prey to the notion they have never left an object in a patient, Mr. Miersma explains.
"I think everybody cares, but the challenge is that not everyone knows about the true extent of the problem," he adds. "If these events happen 11 times a day, and those only are the cases that are actually reported, how can you be so sure you haven't contributed to it?"
Mr. Miersma cites two core reasons retained surgical sponges are common in healthcare:
Healthcare is slow to adopt technology. "Healthcare is slower to adopt technology than almost any other industry. Some of this is related to the perceived financial limitations involved in healthcare. Some of that entails hospitals being clinically oriented," he says.
Other industries can readily adopt technology without facing various regulations which may stifle innovation. Often, a healthcare provider has to prove technology is efficient and effective through clinical evidence while other industries assume "almost any technology is better than no technology and then move forward [with implementation]."
Nurses are often multitasking. Nurses and other OR staff members are in charge of ensuring the number of sponges is the same before and after the procedure. In the bustle of the operating room, nurses often have to multitask, which may interfere with their counting ability.
"All nurses know of the cases involving retained surgical sponges but no one thinks it has happened to them," he says. "No nurse intentionally misses a sponge, just like no one tries to do too many things at once."
The operating room's chaos may have dire consequences, as nurses sometimes are forced to do a handful of tasks at the end of the procedure including entering a slew of information into a patient's electronic health records and getting warm blankets for the patient. While two OR staff members manually count the sponges before and after the procedure, multitasking can still introduce significant risk, which is where SurgiCount comes into play.
How Stryker's SurgiCount is addressing the problem
Stryker acquired SurgiCount last year, with the company paving the way for professionals to safely and effectively count sponges throughout the surgical process. Since its inception in 2007, providers have used SurgiCount Safety-Sponge System in more than 10 million procedures. When Stryker works with practices to implement SurgiCount, the education portion entails two elements — the problem education and the product education. During the problem education, Stryker works with faculty to emphasize that it is a very real problem so both parties can work to combat it. "You have to be intellectually honest and admit that if you have been a nurse for 30 years, there is a chance a patient you have cared for has had a retained surgical sponge," Mr. Miersma says.
After the practice acknowledges the problem, Stryker introduces them to the SurgiCount Safety-Sponge System, which Mr. Miersma refers to as "the most reliable adjunct technology on the market." When using SurgiCount, surgical team members scan the sponges' master tag before breaking the pack of sponges open. The technology knows each sponge's unique serial number, so the technology can ascertain the number of sponges in the pack before and after the procedure. When counting, SurgiCount uses a bar code for each sponge to ensure the count is correct.
Mr. Miersma explains 88 percent of retained sponge cases involve a false correct count,2 with the remaining 12 percent comprising various other scenarios such as trauma cases where surgeons leave in sponges to stop bleeding. Those surgeons will note on the EHR that they placed three sponges in the patient, but X-rays and other providers may not be able to find the sponges later and disregard the EHR note.
"A portion of that 12 percent includes situations where a sponge is acknowledged to be missing," says Mr. Miersma. "But after confirming through X-ray that it is not left in the patient that procedure is completed and the count is left unreconciled."
Even the most renowned practices have cases involving retained surgical sponges. In February 2011, The Joint Commission published a Rochester, Minn.-based Mayo Clinic study which analyzed the practice's sponge counting system over an 18-month period. In the study, providers implemented a data-metric-coded sponge counting system. Prior to DMS system implementation, Mayo encountered a retained sponge once every 64 days. Researchers noted after 18 months, "a DMS system eliminated sponge RSIs from a high-volume surgical practice."3 The system also did not cause any work-flow disruption or increases in case duration.
Within the problem, lays a viable solution. Many providers or healthcare professionals may be hesitant to incorporate technology into their everyday practice, but technology may very well be the much-needed solution to help eliminate the rate of retained surgical sponges. Stryker plans to continue helping medical professionals combat such events, as these events compromise patient safety, which should always be the primary objective of any healthcare practice.
"We are continually hearing from our customers that they want help and technology in the safety space," Mr. Miersma says. "Stryker has a broad and deep footprint in the operating room. Now that we are in this [safety] space, we are doubling our efforts in terms of resources, research and development while continuing to develop better solutions to solve more safety problems."
References
1. Sloan T. August 12, 2013. The High Cost of Inaction: Retained Surgical Sponges are Draining Hospital Finances and Damaging Reputations.
2. Gawande, A et al. Risk Factors for Retained Instruments and Sponges after Surgery. N Engl JMed. 2003; 348:0229-35.
3. Gwendolyn J. Amstutz, MHA; Robert R. Cima, MD, MA; et. al. Using a Data-Matrix–Coded Sponge Counting System Across a Surgical Practice: Impact After 18 Months. 2011: 37:2.
