Chipped sponges, 'magic' wand help ensure patient safety

EISENHOWER ARMY MEDICAL CENTER, Fort Gordon, Ga. (July 1, 2015) -- Retained Surgical Items refers to things inadvertently left in body spaces following an operation. If not detected and removed, these items can cause infection and other complications. RSI can also lead to additional surgeries, and increase the hospital staff and the facility's exposure to liability.

In short, keeping track of things as seemingly insignificant as a sponge, is a big deal.

The surgery department at Eisenhower Army Medical Center handles, on average, 20 surgical cases each day, according to Col. James Frizzi, EAMC's chief of surgery.

For Frizzi and the entire surgical team, eliminating RSI is a significant part of every case. The teams are helped through a simple, but high-tech system: radio-frequency identification, commonly known as RFID chips.

The sponges, typically 4"x4" or 18"x18" laparotomy pads, are used in many surgeries, mostly chest, abdomen or gynecological, to soak up fluids in the surgical field, said Staff Sgt. Kyle Newell, operating room NCOIC. Each sponge is counted as it is used and must be accounted for before the patient can be sewn up.

Nine sponges in. Nine sponges out, for example. The problem begins if the count comes up short. Thanks to the RFID technology, however, a quick pass with a special wand will quickly narrow the location of the missing sponge so it can be retrieved. Without RFID, the search for a soaked and bloody sponge covers the entire surgical field.

In an Aug. 12, 2013 article in Becker's Infection Control and Clinical Quality, a publication a publication that provides "guidance and analysis on infection control, quality, patient safety and accreditation issues" for the healthcare industry, RSI is a relatively rare occurrence, approximately one in 5,500 operations, according to a study by The Mayo Clinic. However, "it appears that roughly two-thirds of all retained surgical items are sponges … About half of the retained sponges were missed by the X-ray machines."

Although reporting requirements vary from state to state, industry estimates for occurrences of RSI range from 2,000-4,000 per year in the United States, according to the NoThing Left Behind project, an educational project for healthcare organizations to prevent RSI.

In the past five years, EAMC has performed 23,100 surgeries, Frizzi said. "In 23,100 cases, we had zero retained sponges."

EAMC strives to deliver zero preventable harm to its patients and become a high-reliability organization. Zero retained sponges over a five-year span is a good indication of the hospital's progress toward that goal.

Although the RFID technique has proved invaluable for those who use it, the nearly 10-year-old technology has not been widely adopted, Frizzi said. Some cite cost as a deterrent.

Frizzi begs to differ. "The cost per case is less than $13," he said. And that includes the equipment, sponges and a sterile sleeve that covers the wand. "And [the wand procedure] takes 15 seconds per patient," he said.

The greater risk lies in not using the system.

"The Risk Management Foundation of the Harvard Medical Institutions," according to the Becker article, "reviewed its data base of thousands of malpractice closed [sic] claims. It found that the average indemnity payout for a claim involving retained surgical items for hospitals and physicians was approximately $473,000 from 2007-2011. For cases involving permanent major damage to a patient, the average claim was $2 million."

In late June, an assessment team from the Surgeon General's office visited EAMC to review 13 different areas of the hospital. The surgical review team "took our RFID practices to consider for use Army-wide," said Frizzi.

The chip itself is no bigger than a grain of rice. In fact, many veterinarians are "chipping" dogs to make them easier to identify if the dog is ever lost. It's a simple matter to put that inexpensive technology to work in a "chipped" sponge and help ensure surgical patients don't go home with a sponge lodged where it doesn't belong: in their bodies.

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CUTLINE (150701-A-QL267-006): Lt. Col. Shane Crask, chief of surgical nursing at Fort Gordon, Georgia's, Eisenhower Army Medical Center, uses a wand to electronically track down a hidden surgical sponge with an imbedded Radio Frequency Identification chip. Using chipped sponges helps ensure patient safety by improving accountability for all sponges used during a surgical procedure. (Photo by David M. White/RELEASED)