A more complete, more cost-effective approach to preventing retained surgical sponges: RFID

By David Palmer, CEO, ClearCount Medical Solutions

It's been a little more than a year since the Centers for Medicaid and Medicare (CMS) made official their policy of non-reimbursement for retained surgical items. This "Never Event" is the most frequent and most costly avoidable surgical complication according to CMS, while also serving as a leading Sentinel Event. Surgical sponges top the list for items that can be left behind. Currently manual counting is the most commonly used method for prevention, but after many years of continued practice refinement, many experts suggest we have hit the human performance barrier. With an estimated incidence of 1 in 1,500 abdominal surgeries, this avoidable complication is in need of better approach.

Today, the policies of both the AORN and the ACS support the use of radiographic or other technologies to ensure removal of all potential foreign bodies from the surgical site.

Which is where today's RFID comes in, as the only technology that can provide a platform to support both detection and counting. The system uses a small, passive RFID tag securely embedded in each sponge. Unlike other options, RFID allows for each sponge to be uniquely identified and does not require a line-of-sight reader for identification, allowing it to easily identify both "how many" and "which" sponges are being managed. RFID counts multiple sponges and reads through blood and tissue.

A Cost Effective Solution
Hospitals can adopt counting and detection at the rate of about $30 per procedure. Recent analysis for hospitals evaluating the counting and detection RFID product currently on the market, the SmartSponge® System, found that hospitals could benefit financially while improving patient safety. This analysis took into account the hospital indemnity, professional indemnity, defense expenses, surgical expenses, x-ray costs, and O.R. delays, which result in an average $90 cost per case. This analysis didn't address other factors such as the impact on hospital's reputation and the public relations nightmare that can occur from even one left-behind sponge. If you can find a comparable patient safety investment, you should also implement that one, too! 

Those looking for a less expensive option now may opt for a reusable RFID detection-only system, in which manual counts can benefit from the safety net of a scan of the patient with a portable wand. This provides an extendible technology at a lower cost, and with a fully reusable wand that offers less waste, with added safety in every case.

The time has come for RFID use to prevent retained sponges.

1) RFID can be used in a wide range of procedures.

The small tag can be placed on all size sponges, lap and surgical towels. Sponges are easily scanned in, individually validated in seconds with no line-of-sight manipulation requirement. RFID is appropriate for the full range of surgeries, providing additional safety in every surgical case.

2) Passive RFID tags provide critical accuracy consistent with the O.R. environment

RFID technology is well established where critical accuracy is required. Today's only RFID-based sponge count and detection system has demonstrated its ability to meet all technical requirements in the O.R.

3) RFID is also poised to become the technology of choice for instrument management and the prevention of retained instruments

The U.S. Government has granted ClearCount Medical Solutions a grant to pursue development of a system for future applications of the RFID technology to surgical instruments. R&D toward RFID for instrument management is progressing rapidly toward future products.

So, How Does RFID Work to Prevent Retained Sponges?

Patient safety continues to be a top concern for hospitals and hospital providers. The RFID-based platform addresses next generation patient safety by providing a comprehensive solution to drive efficiency while preventing medical errors.

What are the other options?

Bar-code counting. Through a line-of-sight approach similar to grocery store check-outs, sponges are manually scanned through the device. They must be counted one at a time just like the manual count. This works to reduce human error, but it hinders efficiency, particularly disruptive in the hectic O.R. environment. And it increases the amount of time nurses must spend handling bio-waste, smoothing out soiled sponges to reveal the bar-code. Furthermore, there is the issue of the missing sponge event. What can the bar-code reader do to locate a sponge lodged in the body cavity? Unfortunately, not much.

Radio Frequency Detection. Older technology that reads a frequency disturbance has also been used in this application. Unfortunately the lack of data transfer means the device cannot determine a sponge type or quantity and is susceptible to "false positives."  An expensive wand can only be used for 24 hours, is not transportable (if unplugged it becomes inoperable) from O.R. to O.R., and generates enormous plastic waste. For a twenty O.R. facility using the system daily, this can amount to more than two tons of plastic waste each year.