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Sánchez-Brizuela G, Santos-Criado FJ, Sanz-Gobernado D, de la Fuente-López E, Fraile JC, Pérez-Turiel J, Cisnal A. Gauze Detection and Segmentation in Minimally Invasive Surgery Video Using Convolutional Neural Networks. SENSORS (BASEL, SWITZERLAND) 2022; 22:5180. [PMID: 35890857 PMCID: PMC9319965 DOI: 10.3390/s22145180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
Medical instruments detection in laparoscopic video has been carried out to increase the autonomy of surgical robots, evaluate skills or index recordings. However, it has not been extended to surgical gauzes. Gauzes can provide valuable information to numerous tasks in the operating room, but the lack of an annotated dataset has hampered its research. In this article, we present a segmentation dataset with 4003 hand-labelled frames from laparoscopic video. To prove the dataset potential, we analyzed several baselines: detection using YOLOv3, coarse segmentation, and segmentation with a U-Net. Our results show that YOLOv3 can be executed in real time but provides a modest recall. Coarse segmentation presents satisfactory results but lacks inference speed. Finally, the U-Net baseline achieves a good speed-quality compromise running above 30 FPS while obtaining an IoU of 0.85. The accuracy reached by U-Net and its execution speed demonstrate that precise and real-time gauze segmentation can be achieved, training convolutional neural networks on the proposed dataset.
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Affiliation(s)
- Guillermo Sánchez-Brizuela
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), Universidad de Valladolid, Paseo del Cauce 59, 47011 Valladolid, Spain; (D.S.-G.); (E.d.l.F.-L.); (J.-C.F.); (J.P.-T.); (A.C.)
| | - Francisco-Javier Santos-Criado
- Escuela Técnica Superior de Ingenieros Industriales, Universidad Politécnica de Madrid, Calle de José Gutiérrez Abascal, 2, 28006 Madrid, Spain;
| | - Daniel Sanz-Gobernado
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), Universidad de Valladolid, Paseo del Cauce 59, 47011 Valladolid, Spain; (D.S.-G.); (E.d.l.F.-L.); (J.-C.F.); (J.P.-T.); (A.C.)
| | - Eusebio de la Fuente-López
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), Universidad de Valladolid, Paseo del Cauce 59, 47011 Valladolid, Spain; (D.S.-G.); (E.d.l.F.-L.); (J.-C.F.); (J.P.-T.); (A.C.)
| | - Juan-Carlos Fraile
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), Universidad de Valladolid, Paseo del Cauce 59, 47011 Valladolid, Spain; (D.S.-G.); (E.d.l.F.-L.); (J.-C.F.); (J.P.-T.); (A.C.)
| | - Javier Pérez-Turiel
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), Universidad de Valladolid, Paseo del Cauce 59, 47011 Valladolid, Spain; (D.S.-G.); (E.d.l.F.-L.); (J.-C.F.); (J.P.-T.); (A.C.)
| | - Ana Cisnal
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), Universidad de Valladolid, Paseo del Cauce 59, 47011 Valladolid, Spain; (D.S.-G.); (E.d.l.F.-L.); (J.-C.F.); (J.P.-T.); (A.C.)
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Sirihorachai R, Saylor KM, Manojlovich M. Interventions for the Prevention of Retained Surgical Items: A Systematic Review. World J Surg 2021; 46:370-381. [PMID: 34773133 PMCID: PMC10186264 DOI: 10.1007/s00268-021-06370-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Retained surgical items (RSI) are preventable error events. Interest in reducing RSI is increasing globally because of increasing demand for safe surgery. While research of interventions to prevent RSI have been reported, no rigorous analysis of the type and effectiveness of interventions exists. This systematic review examines (1) what types of intervention have been implemented to prevent RSI; and (2) what is the effectiveness of those interventions. METHODS We performed a systematic review of PubMed, Embase, CINAHL, Cochrane Library, Scopus, ClinicalTrials.gov, Mednar, and OpenGrey databases. Two reviewers independently screened a total of 1,792 titles and abstracts, and reviewed 87 full-text articles, resulting in 17 articles in the final analysis. Study characteristics included qualitative and quantitative studies that examined the effectiveness of RSI prevention interventions for adult patients who undergo open surgery. The primary outcome was RSI and related error events. RESULTS Four studies and 13 quality improvement projects described RSI interventions categorized into four groups: (1) technology-based, (2) communication-based, (3) practice- or guideline-based, (4) interventions that fell into more than one category. Following guidance in the Quality Improvement minimum quality criteria set, the quality of all studies ranged from poor to fair. Heterogeneity in the interventions used and variable study quality limit our confidence in the interventions' ability to reduce RSI. CONCLUSION Since technology-based interventions may not be financially feasible in low and middle-income countries (LMIC), in those settings interventions that target the social system may be more appropriate. Rigorous methods to investigate local contexts and build knowledge are needed so that interventions to prevent RSI have a greater likelihood of success.
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Affiliation(s)
- Rattima Sirihorachai
- Faculty of Nursing, Mahidol University, 2 Wang Lang Road, Siriraj, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Kate M Saylor
- MSI, Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
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Grant EK, Gattamorta KA, Foronda CL. Reducing the risk of unintended retained surgical sponges: A quality improvement project. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.pcorm.2020.100099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kusuda K, Yamashita K, Tanaka S, Tanaka K, Ohta Y. Development of a Surgical Sponge Counting System Using Radiographic Images. Surg Innov 2020; 27:647-652. [PMID: 32723214 PMCID: PMC7890693 DOI: 10.1177/1553350620943349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background. Retention of surgical sponges in patients is a relatively frequent medical malpractice. To prevent it, the surgical sites are scanned using X-ray. However, using radiography in the operation room induces X-ray exposure for both patients and staff. To prevent such issues, a novel sponge counting system was developed. Each surgical sponge used in common hospitals is composed of single radiopaque fibers. Methods. The proposed system scans surgical sponges to estimate their fiber length (EFL) and returns the number of it. In this study, an optimal image acquisition protocol was determined that allows an accurate count of sponges. X-ray doses and multi-angle image procedures were tested. Results. Measurement trials were performed and compared for both dry and blood-soaked sponges. As a result, the X-ray dose of 50 kV and 600 μA and the acquisition of 180 images per sample yielded an accurate EFL. The 180-image protocol achieved good performance in this study and allowed counting of one package of 10 sponges in 226 seconds. For these settings, a significant correlation was found between the actual number of sponges and the estimated fiber lengths. Additionally, the performance of the system was similar for either dry or blood-soaked items. Conclusion. The proposed system could accurately count surgical sponges and is a promising option in preventing the accidental retention of surgical sponges.
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Affiliation(s)
- Kaori Kusuda
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, 13131Tokyo Women's Medical University, Japan
| | | | - Shinichi Tanaka
- Department of Surgery, St Marianna University, Kanagawa, Japan
| | | | - Yuji Ohta
- Department of Human Environmental Sciences, 12992Ochanomizu University, Tokyo, Japan
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de la Fuente López E, Muñoz García Á, Santos Del Blanco L, Fraile Marinero JC, Pérez Turiel J. Automatic gauze tracking in laparoscopic surgery using image texture analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 190:105378. [PMID: 32045796 DOI: 10.1016/j.cmpb.2020.105378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 01/17/2020] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Inadvertent retained surgical gauzes are an infrequent medical error but can have devastating consequences in the patient health and in the surgeon professional reputation. This problem seems easily preventable implementing standardized protocols for counting but due to human errors it still persists in surgery. The omnipresence of gauzes, their small size, and their similar appearance with tissues when they are soaked in blood make this error eradication really complex. In order to reduce the risk of accidental retention of surgical sponges in laparoscopy operations, in this paper we present an image processing system that tracks the gauzes on the video captured by the endoscope. METHODS The proposed image processing application detects the presence of gauzes in the video images using texture analysis techniques. The process starts dividing the video frames into square blocks and each of these blocks is analyzed to determine whether it is similar to the gauze pattern. The video processing algorithm has been tested in a laparoscopic simulator under different conditions: with clean, slightly stained and soaked in blood gauzes as well as against different biological background tissues. Several methods, including different Local Binary Patterns (LBP) techniques and a convolutional neural network (CNN), have been analyzed in order to achieve a reliable detection in real time. RESULTS The proposed LBP algorithm classifies the individual blocks in the image with 98% precision and 94% sensitivity which is sufficient to make a robust detection of any gauze that appears in the endoscopic video even if it is stained or soaked in blood. The results provided by the CNN are superior with 100% precision and 97% sensitivity, but due to the high computational demand, real-time video processing is not attainable in this case with standard hardware. CONCLUSIONS The algorithm presented in this paper is a valuable tool to avoid the retention of surgical gauzes not only because of its reliability but also because it processes the video transparently and unattended, without the need for additional manipulation of special equipment in the operating room.
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Affiliation(s)
- Eusebio de la Fuente López
- ITAP (Instituto de Tecnologías Avanzadas de la Producción), University of Valladolid, School of Industrial Engineering, Paseo del Cauce, 59, 47011 Valladolid, Spain.
| | - Álvaro Muñoz García
- ITAP (Instituto de Tecnologías Avanzadas de la Producción), University of Valladolid, School of Industrial Engineering, Paseo del Cauce, 59, 47011 Valladolid, Spain.
| | - Lidia Santos Del Blanco
- ITAP (Instituto de Tecnologías Avanzadas de la Producción), University of Valladolid, School of Industrial Engineering, Paseo del Cauce, 59, 47011 Valladolid, Spain.
| | - Juan Carlos Fraile Marinero
- ITAP (Instituto de Tecnologías Avanzadas de la Producción), University of Valladolid, School of Industrial Engineering, Paseo del Cauce, 59, 47011 Valladolid, Spain.
| | - Javier Pérez Turiel
- ITAP (Instituto de Tecnologías Avanzadas de la Producción), University of Valladolid, School of Industrial Engineering, Paseo del Cauce, 59, 47011 Valladolid, Spain.
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The Impact of Surgical Count Technology on Retained Surgical Items Rates in the Veterans Health Administration. J Patient Saf 2020; 16:255-258. [PMID: 32217934 DOI: 10.1097/pts.0000000000000656] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of the study was to compare retained surgical item (RSI) rates for 137 Veterans Health Administration Surgery Programs with and without surgical count technology and the root cause analysis (RCA) for soft good RSI events between October 1, 2009 and December 31, 2016. A 2017 survey identified 46 programs to have independently acquired surgical count technology. METHODS Retained surgical item rates were calculated by the sum of events (sharp, soft good, instrument) divided by the total procedures performed. The RCAs for RSI events were analyzed using codebooks for procedure type/location and root cause characterization. RESULTS One hundred twenty-four RSI events occurred in 2,964,472 procedures for an overall RSI rate of 1/23,908 procedures. The RSI rates for 46 programs with surgical count technology were significantly higher in comparison with 91 programs without a surgical count technology system (1/18,221 versus 1/30,593, P = 0.0026). The RSI rates before and after acquiring the surgical count technology were not significantly different (1/17,508 versus 1/18,673, P = 0.8015). Root cause analyses for 42 soft good RSI events identified multiple associated disciplines (general surgery 26, urology 5, cardiac 4, neurosurgery 3, vascular 2, thoracic 1, gynecology 1) and locations (abdomen 26, thorax 7, retroperitoneal 4, paraspinal 2, extremity 1, pelvis 1, and head/neck 1). Human factors (n = 24), failure of policy/procedure (n = 21), and communication (n = 19) accounted for 64 (65%) of the 98 root causes identified. CONCLUSIONS Acquisition of surgical count technology did not significantly improve RSI rates. Soft good RSI events are associated with multiple disciplines and locations and the following dominant root causes: human factors, failure to follow policy/procedure, and communication.
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Ershadi M, Ershadi M, Niaki S. An integrated HFMEA-DES model for performance improvement of general hospitals. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2020. [DOI: 10.1108/ijqrm-08-2019-0277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeHealthcare failure mode and effect analysis (HFMEA) identifies potential risks and defines preventive actions to reduce the effects of risks. In addition, a discrete event simulation (DES) could evaluate the effects of every improvement scenario. Consequently, a proposed integrated HFMEA-DES model is presented for quality improvement in a general hospital.Design/methodology/approachIn the proposed model, HFMEA is implemented first. As any risk in the hospital is important and that there are many departments and different related risks, all defined risk factors are evaluated using the risk priority number (RPN) for which related corrective actions are defined based on experts' knowledge. Then, a DES model is designed to determine the effects of selected actions before implementation.FindingsResults show that the proposed model not only supports different steps of HFMEA but also is highly in accordance with the determination of real priorities of the risk factors. It predicts the effects of corrective actions before implementation and helps hospital managers to improve performances.Practical implicationsThis research is based on a case study in a well-known general hospital in Iran.Originality/valueThis study takes the advantages of an integrated HFMEA-DES model in supporting the limitation of HFMEA in a general hospital with a large number of beds and patients. The case study proves the effectiveness of the proposed approach for improving the performances of the hospital resources.
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Steelman VM, Schaapveld AG, Storm HE, Perkhounkova Y, Shane DM. The Effect of Radiofrequency Technology on Time Spent Searching for Surgical Sponges and Associated Costs. AORN J 2019; 109:718-727. [PMID: 31135978 DOI: 10.1002/aorn.12698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Retained surgical items (eg, sponges, instruments) remain the most frequently reported sentinel events. The primary strategy for preventing retained sponges is the sponge count. Reconciling sponge counts is time consuming and can extend the duration of operative and other invasive procedures. The primary objective of this observational study was to evaluate the effect of a radiofrequency (RF) surgical-sponge detection system on time spent searching for surgical sponges. The study included 27,637 procedures during nine months before and after implementing an RF surgical-sponge detection system. After implementation of the system, time spent searching for sponges was reduced by 79.58%, the percentage of unreconciled counts was reduced by 71.28%, and time spent using radiography to rule out a retained sponge was reduced by 46.31%. This resulted in a reduction of costs. These findings should be used as part of a comprehensive cost analysis of alternative methods when evaluating RF sponge detection technology.
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Oehme F, Rühle A, Stickel M, Metzger J, Gass J. The sucked surgical sponge: Rare case of Gossypiboma after vaginal hysterectomy. Clin Case Rep 2019; 7:753-757. [PMID: 30997079 PMCID: PMC6452485 DOI: 10.1002/ccr3.2074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/30/2018] [Accepted: 01/11/2019] [Indexed: 11/17/2022] Open
Abstract
Retained surgical material needs to be a possible differential diagnosis for patients presenting with unspecific abdominal pain after especially cavitary emergency surgery. Even though international standard checklists concerning sponge handling and counting exist, RSM could never be ruled out completely.
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Affiliation(s)
- Florian Oehme
- Departement of Visceral‐, Thoracic‐ and Vascular SurgeryUniversity Hospital DresdenDresdenGermany
| | - Annika Rühle
- Departement of General SurgeryCantonal Hospital LucerneLuzernSwitzerland
| | - Michael Stickel
- Departement of General SurgeryCantonal Hospital LucerneLuzernSwitzerland
| | - Jürg Metzger
- Departement of General SurgeryCantonal Hospital LucerneLuzernSwitzerland
| | - Jörn‐Markus Gass
- Departement of General SurgeryCantonal Hospital LucerneLuzernSwitzerland
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Rodriguez FR, Kirby BM, Ryan J. Evaluation of factors associated with retained surgical sponges in veterinary patients: a survey of veterinary practitioners. J Small Anim Pract 2018; 59:570-577. [DOI: 10.1111/jsap.12873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/26/2018] [Accepted: 05/04/2018] [Indexed: 11/28/2022]
Affiliation(s)
- F. R. Rodriguez
- Department of Small Animal Surgery; Animal Bluecare Hospital; A7 Km 204, 29649, Mijas Costa Malaga Spain
| | - B. M. Kirby
- Department of Small Animal Surgery; University College Dublin School of Veterinary Medicine; Belfield Campus, Dublin 4 Ireland
| | - J. Ryan
- Royal (Dick) School of veterinary Studies; University of Edinburgh, Easter Bush Veterinary Centre; Roslin Midlothian, EH25 9RG UK
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Steelman VM, Shaw C, Shine L, Hardy-Fairbanks AJ. Retained surgical sponges: a descriptive study of 319 occurrences and contributing factors from 2012 to 2017. Patient Saf Surg 2018; 12:20. [PMID: 29988638 PMCID: PMC6027759 DOI: 10.1186/s13037-018-0166-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/13/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Unintended retention of foreign bodies remain the most frequently reported sentinel events. Surgical sponges account for the majority of these retained items. The purpose of this study was to describe reports of unintentionally retained surgical sponges (RSS): the types of sponges, anatomic locations, accuracy of sponge counts, contributing factors, and harm, in order to make recommendations to improve perioperative safety. METHODS A retrospective review was undertaken of unintentionally RSS voluntarily reported to The Joint Commission Sentinel Event Database by healthcare facilities over a 5-year period (October 1, 2012- September 30, 2017). Event reports involving surgical sponges were reviewed for patients undergoing surgery, invasive procedures, or child birth. RESULTS A total of 319 events involving RSS were reported. Sponges were most frequently retained in the abdomen or pelvis (50.2%) and the vagina (23.9%). Events occurred in the Operating Room (64.1%), Labor and Delivery (32.7%) and other procedural areas (3.3%). Of the events reported, 318 involved 1 to 12 contributing factors totaling 1430 in 13 different categories, most frequently in human factors and leadership. In 69.6% of reports, the harm was an unexpected additional care or extended stay. Severe temporary harm was associated with 14.7% of the events. One patient died as a result of the retained sponge. CONCLUSIONS Because of the complexity of perioperative patient care, the multitude of contributing factors that are difficult to control, and the potential benefit of radiofrequency sponge detection, we recommend that this technology be considered in areas where surgery is performed and in Labor and Delivery.
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Affiliation(s)
- Victoria M. Steelman
- The University of Iowa College of Nursing, 50 Newton Road, Iowa City, IA 52242-1121 USA
| | - Clarissa Shaw
- The University of Iowa College of Nursing, 50 Newton Road, Iowa City, IA 52242-1121 USA
| | - Laurel Shine
- The Joint Commission, 1 Renaissance Boulevard, Oak Brook Terrace, IL 60181 USA
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A Socio-Technical Exploration for Reducing & Mitigating the Risk of Retained Foreign Objects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040714. [PMID: 29642646 PMCID: PMC5923756 DOI: 10.3390/ijerph15040714] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/16/2018] [Accepted: 04/04/2018] [Indexed: 11/24/2022]
Abstract
A Retained Foreign Object (RFO) is a fairly infrequent but serious adverse event. An accurate rate of RFOs is difficult to establish due to underreporting but it has been estimated that incidences range between 1/1000 and 1/19,000 procedures. The cost of a RFO incident may be substantial and three-fold: (i) the cost to the patient of physical and/or psychological harm; (ii) the reputational cost to an institution and/or healthcare provider; and (iii) the financial cost to the taxpayer in the event of a legal claim. This Health Research Board-funded project aims to analyse and understand the problem of RFOs in surgical and maternity settings in Ireland and develop hospital-specific foreign object management processes and implementation roadmaps. This project will deploy an integrated evidence-based assessment methodology for social-technical modelling (Supply, Context, Organising, Process & Effects/ SCOPE Analysis Cube) and bow tie methodologies that focuses on managing the risks in effectively implementing and sustaining change. It comprises a multi-phase research approach that involves active and ongoing collaboration with clinical and other healthcare staff through each phase of the research. The specific objective of this paper is to present the methodological approach and outline the potential to produce generalisable results which could be applied to other health-related issues.
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Sullivan JL, Rivard PE, Shin MH, Rosen AK. Applying the High Reliability Health Care Maturity Model to Assess Hospital Performance: A VA Case Study. Jt Comm J Qual Patient Saf 2017; 42:389-411. [PMID: 27535456 DOI: 10.1016/s1553-7250(16)42080-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The lack of a tool for categorizing and differentiating hospitals according to their high reliability organization (HRO)-related characteristics has hindered progress toward implementing and sustaining evidence-based HRO practices. Hospitals would benefit both from an understanding of the organizational characteristics that support HRO practices and from knowledge about the steps necessary to achieve HRO status to reduce the risk of harm and improve outcomes. The High Reliability Health Care Maturity (HRHCM) model, a model for health care organizations' achievement of high reliability with zero patient harm, incorporates three major domains critical for promoting HROs-Leadership, Safety Culture, and Robust Process Improvement ®. A study was conducted to examine the content validity of the HRHCM model and evaluate whether it can differentiate hospitals' maturity levels for each of the model's components. METHODS Staff perceptions of patient safety at six US Department of Veterans Affairs (VA) hospitals were examined to determine whether all 14 HRHCM components were present and to characterize each hospital's level of organizational maturity. RESULTS Twelve of the 14 components from the HRHCM model were detected; two additional characteristics emerged that are present in the HRO literature but not represented in the model-teamwork culture and system-focused tools for learning and improvement. Each hospital's level of organizational maturity could be characterized for 9 of the 14 components. DISCUSSION The findings suggest the HRHCM model has good content validity and that there is differentiation between hospitals on model components. Additional research is needed to understand how these components can be used to build the infrastructure necessary for reaching high reliability.
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Affiliation(s)
- Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, USA
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The Role of Radio Frequency Detection System Embedded Surgical Sponges in Preventing Retained Surgical Sponges: A Prospective Evaluation in Patients Undergoing Emergency Surgery. Ann Surg 2017; 264:599-604. [PMID: 27433911 DOI: 10.1097/sla.0000000000001872] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To prospectively evaluate the ability of radio frequency detection (RFD) system-embedded sponges to mitigate the incidence of retained surgical sponges (RSS) after emergency surgery. BACKGROUND Emergency surgery patients are at high risk for retained foreign bodies. METHODS All emergent trauma and nontrauma cavitary operations over a 5-year period (January 2010-December 2014) were prospectively enrolled. For damage-control procedures, only the definitive closure was included. RFD sponges were used exclusively throughout the study period. Before closure, the sponge and instrument count was followed by RFD scanning and x-ray evaluation for retained sponges. RSS and near-misses averted using the RFD system were analyzed. RESULTS In all, 2051 patients [median (range)], aged 41 (1-101) years, 72.2% male, 46.8% trauma patients, underwent 2148 operations (1824 laparotomy, 100 thoracotomy, 30 sternotomy, and 97 combined). RFD detected retained sponges in 11 (0.5%) patients (81.8%laparotomy, 18.2% sternotomy) before cavitary closure. All postclosure x-rays were negative. No retained sponges were missed by the RFD system. Body mass index was 29 (23-43), estimated blood loss 1.0 L (0-23), and operating room time 160 minutes (71-869). Procedures started after 18:00 to 06:00 hours in 45.5% of the patients. The sponge count was incorrect in 36.4%, not performed due to time constraints in 45.5%, and correct in 18.2%. The additional cost of using RFD-embedded disposables was $0.17 for a 4X18 laparotomy sponge and $0.46 for a 10 pack of 12ply, 4X8. CONCLUSIONS Emergent surgical procedures are high-risk for retained sponges, even when sponge counts are performed and found to be correct. Implementation of a RFD system was effective in preventing this complication and should be considered for emergent operations in an effort to improve patient safety.
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The Hidden Costs of Reconciling Surgical Sponge Counts. AORN J 2015; 102:498-506. [PMID: 26514707 DOI: 10.1016/j.aorn.2015.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 03/23/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022]
Abstract
Retained surgical sponges are serious adverse events that can result in negative patient outcomes. The primary method of prevention is the sponge count. Searching for sponges to reconcile counts can result in inefficient use of OR time. The purpose of this descriptive study was to estimate the cost of nonproductive OR time (ie, time spent not moving forward with the surgical procedure) spent reconciling surgical sponge counts and the cost of using radiography to rule out the presence of retained sponges. We included 13,322 patient surgeries during a nine-month period. Perioperative personnel required from one to 90 minutes of additional time to reconcile each of 212 incorrect/unresolved counts. The total annualized cost of OR time spent searching for sponges and ruling out the presence of potentially retained sponges using radiography was $219,056. These costs should be included in comprehensive cost analyses when considering alternatives to supplement the surgical count.
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Retained Surgical Sponges: Findings from Incident Reports and a Cost-Benefit Analysis of Radiofrequency Technology. J Am Coll Surg 2014; 219:354-64. [DOI: 10.1016/j.jamcollsurg.2014.03.052] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/21/2014] [Accepted: 03/24/2014] [Indexed: 01/24/2023]
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Donnelly T. Two, four, six, eight... stop and count before it is too late! An audit on swab, needle and instrument counts in theatre. J Perioper Pract 2014; 24:178-81. [PMID: 25109035 DOI: 10.1177/1750458914024007-804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A concurrent audit was conducted over a four week period to determine if the counting of swabs, needles and instruments for surgery adhered to local policy and recommended guidelines. Data were collected on 30 abdominal surgical procedures. This audit highlighted failings in the count process. It identified poor communication within the multidisciplinary team. There needs to be an increased awareness about local policy, national and international guidelines regarding the counting of swabs, needles and instruments for all surgical procedures.
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Steelman VM. Retained surgical sponges, needles and instruments. Ann R Coll Surg Engl 2014. [PMID: 24780693 DOI: 10.1308/xxx] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Judson TJ, Howell MD, Guglielmi C, Canacari E, Sands K. Miscount incidents: a novel approach to exploring risk factors for unintentionally retained surgical items. Jt Comm J Qual Patient Saf 2013; 39:468-74. [PMID: 24195200 DOI: 10.1016/s1553-7250(13)39060-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND An estimated 1,500 operations result in retained surgical items (RSIs) each year in the United States, resulting in substantial morbidity. The rarity of these events makes studying them difficult, but miscount incidents may provide a window into understanding risk factors for RSIs. METHODS A cohort study of all consecutive operative cases during a 12-month period was conducted at a large academic medical center to identify risk factors for surgical miscounts. A multidisciplinary electronic miscount reconciliation checklist (necessitating both surgeon and nurse input) was introduced into the internally developed electronic Perioperative Information Management System to build a predictive model for RSI cases. RESULTS Among 23,955 operations, 84 resulted in miscount incidents (0.35% [95% confidence interval: 0.28% to 0.43%]). Increased case duration was strongly associated with increased risk of a miscount in unadjusted analyses (p < .0001). In the nested case-control analysis, both the case duration and the number of providers present were independently associated with a more than doubling of the odds of a miscount, even after adjustment for one another, the elective/urgent/emergent status of a case, and personnel changes occurring during the case. CONCLUSIONS The finding that both the length of the case and the number of providers involved in the case were independent risk factors for miscount incidents may offer insight into risk-targeted strategies to prevent RSIs, such as postoperative imaging, bar-coded surgical items, and radiofrequency technology. Miscounts trigger use of the Incorrect Count Safety Checklist, which can be used to determine whether a count completed at the procedure's conclusion is consistent across disciplines (circulating nurses, scrub persons, surgeons).
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Steelman VM, Graling PR. Top 10 Patient Safety Issues: What More Can We Do? AORN J 2013; 97:679-98, quiz 699-701. [DOI: 10.1016/j.aorn.2013.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 04/18/2013] [Indexed: 10/26/2022]
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Abstract
When frontline staff do not adhere to policies, protocols, or checklists, managers often regard these violations as indicating poor practice or even negligence. More often than not, however, these policy and protocol violations reflect the efforts of well intentioned professionals to carry out their work efficiently in the face of systems poorly designed to meet the diverse demands of patient care. Thus, non-compliance with institutional policies and protocols often signals a systems problem, rather than a people problem, and can be influenced among other things by training, competing goals, context, process, location, case complexity, individual beliefs, the direct or indirect influence of others, job pressure, flexibility, rule definition, and clinician-centred design. Three candidates are considered for developing a model of safety behaviour and decision making. The dynamic safety model helps to understand the relationship between systems designs and human performance. The theory of planned behaviour suggests that intention is a function of attitudes, social norms and perceived behavioural control. The naturalistic decision making paradigm posits that decisions are based on a wider view of multiple patients, expertise, systems complexity, behavioural intention, individual beliefs and current understanding of the system. Understanding and predicting behavioural safety decisions could help us to encourage compliance to current processes and to design better interventions.
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Affiliation(s)
- Ken Catchpole
- Department of Surgery, Cedars-Sinai Medical Centre, Los Angeles, CA 90048, USA.
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Yang YT, Henry L, Dellinger M, Yonish K, Emerson B, Seifert PC. The Circulating Nurse's Role in Error Recovery in the Cardiovascular OR. AORN J 2012; 95:755-62. [DOI: 10.1016/j.aorn.2011.09.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 08/27/2011] [Accepted: 09/20/2011] [Indexed: 10/28/2022]
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Response to a quality improvement project on improving the surgical count. AORN J 2012; 95:317-8; author reply 318. [DOI: 10.1016/j.aorn.2012.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Author response. AORN J 2012. [DOI: 10.1016/j.aorn.2012.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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