[nukkad] Why Surgical Instruments Get Left Inside

["Nelson Fernandes" <>]

----------------------------------------------------------------------------
The zoo is a prison for animals who have been sentenced without trial and I feel guilty because I do nothing about it. -Russell Hoban, author (1925- )
----------------------------------------------------------------------------

Why Surgical Instruments Get Left Inside

Emergency Surgery One Key Factor

By 	Jennifer Warner
on Wednesday, January 15, 2003

Jan. 16, 2003 -- Accidents sometimes just happen, but certain factors can
increase the risk of some serious medical mistakes happening more often.

A new study in the Jan. 16 issue of The New England Journal of Medicine
shows that items such as metal clamps and other surgical instruments are
more likely to be left inside the patient after surgery in emergency
situations, after an unplanned change in surgical procedure, or when the
patient is obese. Based on the nearly 29 million hospital surgeries
performed each year, the researchers estimate that more than 1,500 cases of
retained foreign objects occur annually in the U.S.

Researchers say leaving sponges or surgical instruments inside patients is
one of the most persistent but poorly understood types of medical errors.

To find out what might increase the likelihood of this rare, yet potentially
dangerous mistake, researchers looked at the records of a major medical
malpractice insurer and identified 54 patients who had a total of 61 foreign
objects left inside them after surgery. They then compared these cases to
235 patients who underwent similar surgical procedures without incident.

The researchers found that about a third of patients who had a foreign
object left inside them had emergency surgery or an unexpected change in
surgical procedure compared to less than 10% of the comparison group.
Patients who had a sponge or instrument left behind were also more likely to
be overweight.

Overall, researchers say having emergency surgery increased the risk of this
type of medical error by nearly nine-fold, and an unplanned change in
procedure increased the risk by about four-fold.

The researchers state that the Association of Operating Room Nurses has long
required that only X-ray detectable sponges be used and that the sponges
should be counted before and after surgery. If all of the sponges are not
accounted for, examination by the surgeon or X-ray must be performed.

Previous studies have shown that some incidents have occurred because
precautions weren't followed, but researchers say even when safety
procedures are followed, some foreign objects still go undetected.

"Often when you hear about these kinds of cases, people assume it is due to
negligence," says study researcher Atul Gawande, MD, MPH, of Brigham and
Women's Hospital in Boston, in a news release. "But we found that these
errors usually occur despite teams following proper procedures. These errors
tend to occur in unpredictable situations, such as emergency operations,
that challenge standard protocols."

"It's important to note ... that emergency situations may impact the
effectiveness of an otherwise well-intentioned inventory of instruments,"
says Gawande. The way to further reduce these errors is to step-up the use
of X-rays and CT scans to ensure that surgical objects are not left behind.

SOURCES: The New England Journal of Medicine, Jan. 16, 2003 • News release,
Brigham and Women's Hospital.



------------------------------------------------------------------------------
To join/leave, use the form at: http://www.mumbai-central.com/nukkad/#options
This list is archived at: http://www.mumbai-central.com/nukkad/archive.html