Sponges - National RFID Centre
Sponges - National RFID Centre
Sponges - National RFID Centre
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Patient Safety Technology In ORImplement a Fail Proof System of Using<strong>RFID</strong> <strong>Sponges</strong>Joann Pang290909ResearchClinical CareEducationCopyright © 2008 <strong>National</strong> University Health System
• Surgeons employ “tools of trade” for surgery• 1 out of 1,500 operations are reported to have foreign objectsunintentionally left in the body after surgery• 54 cases reported, 69% of the cases are related to sponges• 31% involved instrumentsCopyright © 2008 <strong>National</strong> University Health System
• Manual counting of sponges is a accepted practice currently• OR nurses spend at least 15 – 30 minutes accounting forsponges and instruments used during surgery• When there is a discrepancy in sponge count, X rays are thelast line of defense (false reading)• Time-honoured, simple preventive measure is heavilydependent on human performances• Subject to human errorCopyright © 2008 <strong>National</strong> University Health System
• Miscount• Misplaced• Retained SpongeCopyright © 2008 <strong>National</strong> University Health System
Type of Surgical Case Type of <strong>Sponges</strong> Time spent looking forgauzeX Ray doneLaparoscopy appendixconverted to laparotomyRaytex Gauze 1 hour and 30min YesLiver Resection Raytex 1 hour Yes(Rt) Hemicolectomy Raytex 2 hour YesCABG Raytex 2 hour YesCABG Raytex 1 hour YesCopyright © 2008 <strong>National</strong> University Health System
“The incident rate may besmall…… However, anyincident will be one too manyand the ultimate goal will be toaim for zero if possible.”Copyright © 2008 <strong>National</strong> University Health System
• Legal liability issues• Increased insurance premiums• Additional cost associated healthcare services• Damaged reputation• Psychological Stress on the PatientCopyright © 2008 <strong>National</strong> University Health System
DeathPain and Suffering prior todeathBereavementFuneral expenses“Dependency Claim”Up to 10,000Up to $10,000Up to $20,000This can be potentially bigclaim, depending if it’s ahigh income earnerRecovered FinePain and SufferingCurrent and Future relatedmedical costLoss of earnings for theperiodUp to $10,000Copyright © 2008 <strong>National</strong> University Health System
Items Cost / Item Usage Total CostManpower$20 / hour (SN)$30 / hour (NM/NC)$10 / hour (OTA)$350 / hour (Surgeon)$133 / hour (Anesthetist)1.5 SN x 2 = $50SSN x 1 = $75OTA x 1 = $25Surgeon = $875Anesthetist $332.5$133 / hour (Anesthetist) Anesthetist $332.5Cost of X-Ray $150Cost of Re-OperationTotal cost(excludingsettlement fees)$4500$7082.5Copyright © 2008 <strong>National</strong> University Health System
Patient Sequelae• Pain• Sepsis• Re-operation for removal• Intestinal Obstruction• Fistualization• DeathCopyright © 2008 <strong>National</strong> University Health System
PreparatoryPhase• OR nurse performswab count• Document swab countin the nursing recordformDuring Surgery• OR nurse maintain anaccurate inventory ofsponges used• Circulating nursedocuments theadditional number ofsponges givenPost-Operatively• OR nurse conductcount before closureof cavity• Circulating nursedocument and showthe record form to thescrub nurseCopyright © 2008 <strong>National</strong> University Health System
Issue With Current CountingMethod• Labor intensive (occupy as much as 14% of theoperative time)• Time consuming• Rely solely on human visual detection and counting• Risk of inaccuracy• Subject to human errorCopyright © 2008 <strong>National</strong> University Health System
Attributing Factors Leading toInaccurate Sponge Count• Team Fatigue• Difficult / Complex Surgeries• Emergency surgeries / surgeries with multipleprocedures• <strong>Sponges</strong> “sticking together”• Distraction during surgeryCopyright © 2008 <strong>National</strong> University Health System
Copyright © 2008 <strong>National</strong> University Health System
The ProblemCopyright © 2008 <strong>National</strong> University Health System
Bar-coding Surgical <strong>Sponges</strong>• Two dimension bar codedsponges• Handheld countingcomputer• Replace manual countingwith scanning of bar codedsponges• Time consuming• Does not providecontinuous monitoring ofsponges used duringsurgeryCopyright © 2008 <strong>National</strong> University Health System
<strong>RFID</strong> <strong>Sponges</strong>• <strong>Sponges</strong> are embedded with<strong>RFID</strong> chip• <strong>Sponges</strong> are captured by thesystem when it is discardedinto the bin• Wand to scan patient’s bodywhen there is a discrepancyin swab count• Full automation on counting/ tracking of spongesCopyright © 2008 <strong>National</strong> University Health System
To eliminate incidences of retained gauze to zero byimplementing a fail proof system of using “<strong>RFID</strong>” spongesCopyright © 2008 <strong>National</strong> University Health System
Increase the accuracy of sponge counts Potentially reduce the time requirement of performing sponge count Provide a better visibility of tagged sponges used throughout thesurgery Increase efficiency and safety of the operating roomCopyright © 2008 <strong>National</strong> University Health System
Application and use caseInitialization ProcessGauze Initial In-used Soiled10 X 10 123 0 0<strong>RFID</strong> trolley top /ContainerCopyright © 2008 <strong>National</strong> University Health System
Application and use caseIn-use and counting processGauze Initial In-used Soiled10 X 10 10 9 10 01<strong>RFID</strong> trolley top /Container<strong>RFID</strong> binCopyright © 2008 <strong>National</strong> University Health System
Tagged Sponge Count DetailsCopyright © 2008 <strong>National</strong> University Health System
Add SpongeCopyright © 2008 <strong>National</strong> University Health System
Clear Soiled BinCopyright © 2008 <strong>National</strong> University Health System
• Potential increase in revenue• Increase efficiency• Improve Patient Safety in OR• Improvement in workflow• Potential ROI in 4.4 monthsCopyright © 2008 <strong>National</strong> University Health System
• Manpowerneeded to look forsponge$100 • Cost of wastedtime searching for• Cost of X’Raymissing sponges$95$966NB: The time spend looking for gauzes(average time spent = 2 hours) would allowus to do at least one more Table 4 cases or 2– 3 Table 1 casesCopyright © 2008 <strong>National</strong> University Health System
Av Time spent counting gauze /caseAv time spent /surgical procedure/ dayNo. of OT 2No. of case increase / day15min120minAv Revenue / day $1,500Increase in revenue for 2 OT $3,0001 (new case) /OT / dayIncremental increase in revenue $30,000 = 3,000 x 20Copyright © 2008 <strong>National</strong> University Health System
“Not all innovations willsucceed, but if there is noopportunity to evenexperiment, we will be stuckwith the status quo”Copyright © 2008 <strong>National</strong> University Health System
Thank youfor your attentionCopyright © 2008 <strong>National</strong> University Health System
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