Surgical Items Research Articles

Retained Surgical Items at Chest Imaging.

Identification of retained surgical items (RSIs) can be difficult despite the use of radiopaque markers, and key imaging strategies to reduce missed RSIs include maintaining a high index of suspici...

A historical perspective on the problem of the retained surgical sponge: Have we really come that far?

Retained surgical items, particularly surgical sponges, are a considered a “never event.” Unfortunately, they continued to be reported despite significant efforts to reduce them. Our goal was to identify some of the earliest reports of surgical items, particularly surgical sponges, to see how it was presented in the literature as well as any insights into contributing factors and processes to mitigate the event. We progress forward in time to look at how this issue has been addresses or changed as we enter the 21st century. After this review, it appears that our advances are not as significant as those efforts proposed over 100 years ago. We view this as a call to action for significant change in our operative safety processes and to incorporate available technology.

Cost Savings in Urology Operating Rooms by Editing Surgeon Preference Cards.

Operating room costs contribute significantly to the overall expenditure for inpatient care. We evaluated a simple way to reduce urology operating room costs by limiting the loss from unused disposable items. Baseline data were collected on opened and unused disposable items. Surgeons were asked to edit their preference cards and mark optional surgical items that would only be opened if requested. The cost of unused disposable items during the first 4 weeks in 3 operating rooms averaged $410/week. Costs after implementing the intervention declined to an average of $30/week. This yielded $380/week in savings, equating to a 92% reduction in waste, and a potential savings of $19 760 annually in the 2 urology operating rooms alone. Since the urology department represents only 10% of the main operating rooms at our institution, if other operating rooms implemented similar cost saving methods the hospital could potentially accrue significant savings.

Curtailing Unnecessary Waste Among Operating Room Personnel: Evaluating the Cost Awareness of Commonly Used Surgical Items.

Operating rooms (ORs) generate 70% of hospital waste, leading to increased costs for the hospital, patient, and the environment. The lack of cost awareness among physicians has been well documented; however, there is little information on anesthesiologists or ancillary OR staff. This study aimed to evaluate the cost awareness of commonly used items at an academic medical center among OR personnel. Anonymous surveys were distributed to OR personnel (nurses, surgical technicians (STs), nurse anesthetists, anesthesiologists, surgeons, and residents), asking for the estimated costs of ten commonly used items. These costs were then compared against actual costs to evaluate the accuracy of participants' estimates. Responders were clustered by job, highest level of education, and years of experience for comparison. 167 surveys were collected, and overall only 16.4% of estimates were accurate within 50% of actual price. No significant differences in accuracy between groups were identified overall (P = .2), but both surgical and anesthesia attendings had significantly higher rates of correct responses than their respective residents. No difference was seen in accuracy when all attendings (surgeons and anesthesiologists) were compared with either nurses or STs. Linear regression demonstrated no correlation between number of years at current position or years at institution and number of correct responses (R2 = .0025 and R2 = .005, respectively). Addressing the knowledge deficit around item costs via global education of all OR personnel (surgeons, anesthesia providers, and ancillary staff) could be a viable pathway to reduce waste, and thus cost, for our healthcare system.

Hidden Dangers and Preventive Measures in the Inventory of Articles in Operating Room

Operating Room is an important place for surgical diagnosis and treatment and rescue of patients. With the rapid development of medical technology, high, precision, sharp continuous development, operating room safety management is particularly important. The error of the counting of the surgical articles causes the foreign body left in the patient’s body, which will cause irreversible damage to the patient and even cause the medical dispute and touch the legal problem. Operation items inventory system is an important working system in the operating room. Scientific and standardized methods and systems for counting surgical instruments and dressings during operation can prevent foreign bodies from being left in the body, prevent errors and accidents in the operating room, and are very important for ensuring the safety of the operation of patients. In order to ensure the safety of patients, it is necessary to ensure the correct inventory of surgical items. The factors affecting the accuracy of item counting in the operating room and the preventive measures are summarized as follows.

Preventing Retained Surgical Items During Endovascular Procedures: Bridging the Gap Between Guidelines and Practice.

A retained surgical item (RSI) can be a devastating and costly procedural complication. Although the current incidence of RSIs is unknown, perioperative personnel routinely perform surgical counts according to their facility's policies and procedures to prevent this sentinel event. The American College of Surgeons, The Joint Commission, and AORN emphasize the importance of communication and standardized protocols for the counting of surgical items. However, there is a lack of current evidence to support specific recommendations for the counting of items during endovascular procedures. After the occurrence of RSIs during endovascular procedures at our facility, we convened an interdisciplinary workgroup, conducted an analysis of root causes, reviewed the available literature, and revised the existing policy. This article reviews the available literature on RSIs, describes root causes, discusses recommendations from national organizations, and describes the process that we used to create the policy changes at our facility.

Clinical Issues-November 2020.

Using adhesive tape for patient positioning Key words: adhesive tape, surgical tape, patient positioning, pressure injury, contamination. Border sterility of open sterile wrappers Key words: wrapped sterile item, unsterile border, wrapper flap, contaminated, aseptic technique. Cost per minute of OR time Key words: cost comparison, direct costs, cost savings, perioperative efficiency, product evaluation. Packages containing an incorrect number of suture needles Key words: multipack, retained surgical item (RSI), counting, needle, package.

Cost Unconscious: Few Surgeons Are Aware of the Cost of Commonly Used Surgical Items

Cost Unconscious: Few Surgeons Are Aware of the Cost of Commonly Used Surgical Items

Intraoperative Sentinel Events in the Era of Surgical Safety Checklists: Results of a National Survey.

ObjectiveDespite the implementation of advanced health care safety systems including checklists, preventable perioperative sentinel events continue to occur and cause patient harm, disability, and death. We report on findings relating to otolaryngology practices with surgical safety checklists, the scope of intraoperative sentinel events, and institutional and personal response to these events.Study DesignSurvey study.SettingAnonymous online survey of otolaryngologists.MethodsMembers of the American Academy of Otolaryngology–Head and Neck Surgery were asked about intraoperative sentinel events, surgical safety checklist practices, fire safety, and the response to patient safety events.ResultsIn total, 543 otolaryngologists responded to the survey (response rate 4.9% = 543/11,188). The use of surgical safety checklists was reported by 511 (98.6%) respondents. At least 1 patient safety event in the past 10 years was reported by 131 (25.2%) respondents; medication errors were the most commonly reported (66 [12.7%] respondents). Wrong site/patient/procedure events were reported by 38 (7.3%) respondents, retained surgical items by 33 (6.4%), and operating room fire by 18 (3.5%). Although 414 (79.9%) respondents felt that time-outs before the case have been the single most impactful checklist component to prevent serious patient safety events, several respondents also voiced frustrations with the administrative burden.ConclusionSurgical safety checklists are widely used in otolaryngology and are generally acknowledged as the most effective intervention to reduce patient safety events; nonetheless, intraoperative sentinel events do continue to occur. Understanding the scope, causes, and response to these events may help to prioritize resources to guide quality improvement initiatives in surgical safety practices.

Clinical Issues-October 2020.

Bundling cords during laparoscopic procedures Key words: antenna coupling, laparoscopy, monopolar active electrode, burns, thermal injury. Cleaning dirty instruments in scrub sinks Key words: instrument cleaning, instrument decontamination, scrub sinks, manual cleaning, mechanical cleaning. Using cotton balls in neurosurgery Key words: gossypiboma, foreign body granuloma, cotton ball, neurosurgery, retained surgical item (RSI). Surgical hand rub allergies Key words: hand allergy, dermatitis, eczema, hand rub, product trial.

Improving surgical safety checklist completion using distributed responsibility of checklist item completion among operating room team members: A quality improvement project

Background. Surgical safety checklists are a standard of care for safe operating room practice, but their use has not been associated with reductions in adverse perioperative outcomes in some settings. Non-adherence and partial checklist completion may contribute to this lack of effect.
 Objective. To examine whether a surgical safety checklist using distributed responsibility of checklist item completion, by allocation of questions and responses among operating room staff, increases surgical safety checklist compliance.
 Methods. With Quality and Risk Management approval, a multicomponent strategy consisting of novel surgical safety checklist focused on distributed responsibility of checklist item completion was evaluated in orthopaedic operating rooms at The Hospital for Sick Children, Toronto, from July to August 2016 using a before-and-after study design. The intervention consisted of a wall-mounted reusable checklist with questions and responses designated to specific operating room team members. Team training was provided beforehand, operating room team leaders were identified to promote the intervention, and revisions to the checklist content and process were implemented based on feedback on feasibility and clinical sensibility.
 Results. A total of 45 and 59 children were included in pre-intervention and intervention groups, respectively. Overall, 87% (1,354/1,560) of checklist items were observed. Checklist item completion was significantly increased in the post-intervention group (77% [615/802]) compared with the pre-intervention group (27% [150/522]) (P<0.001).
 Conclusions. These findings suggest that a multicomponent strategy of designating responsibility for item completion among operating room team members and using a memory aid can improve compliance with surgical safety checklist item completion.

GAMBARAN KETIDAKLELENGKAPAN PENGISIAN FORMULIR LAPORAN ANESTESI KASUS BEDAH DI RSU IMELDA PEKERJA INDONESIA MEDAN

Every health service provided to patients must recorded in the medical records completely because the completeness of filling the medical record is used as an indicator of the quality of health services in the hospital. The purpose of this study is to determine the incomplete picture of filling out an anesthetic case report form in a surgical case at the Imelda Indonesian Workers Hospital in Medan. The type of research is descriptive. The populations of this study are all forms of anesthesia patient case reports for the first quarter of 2020 with a total of 728 forms. The samples are 88 forms taken using systematic random sampling. Data collection was carried out using the checklist sheet. Data were analyzed univariate to describe the characteristics of each research variable by producing a frequency distribution and percentage of each variable. The results showed that there were 24 anesthetized report forms that were completely filled and 64 anesthetic report forms that were not completely filled. The highest percentage of incompleteness of filling in the patient identity component on the item date of birth was 10 forms (11%), on the anesthesia time component on the old surgical item by 39 forms (44%), on the diagnostic component on the post-surgical diagnostic item by 28 forms (32%), the examination component on the preoperative state item was 63 forms (72%) and the signature component was 2 forms (2%). It is recommended that every health worker who provides health services to surgical case patients fill out the anesthetic report form in accordance with the SPO authorizing the medical record filling, and to the medical record officer to conduct an assembling or complete analysis of medical record documents.

Clinical Issues-September 2020.

Surgical counts during a partial cystectomy Key words: partial cystectomy, retained surgical item (RSI), counts, bladder, guidewire. Preparing the OR for patients who require both airborne and contact precautions Key words: airborne precautions, contact precautions, contamination, Coronavirus Disease 2019 (COVID-19), negative pressure. Preoperative transport of patients who require both airborne and contact precautions Key words: preoperative patient transport, hand hygiene, personal protective equipment (PPE), N95 respirator, Coronavirus Disease 2019 (COVID-19). Postoperative transport of patients who require both airborne and contact precautions Key words: postoperative patient transport, hand hygiene, personal protective equipment (PPE), N95 respirator, Coronavirus Disease 2019 (COVID-19).

Breaking down the silos: Transcatheter aortic valve implant versus open heart surgery.

Budget silos innate to hospital global funding schemes tend to inhibit the adoption of innovative clinical practices. In contrast, budget fluidity can encourage initiatives that align with the Quadruple Aim. This article calculated the budget impact of Surgical Aortic Valve Replacement (SAVR) and Transcatheter Valve Implant (TAVI) in high-risk aortic stenosis to demonstrate the value of a full-cost accounting approach. The budget impact of TAVI was $4,000 more than SAVR ($52,576 vs $48,578). However, the cost of managing SAVR adverse events was higher than TAVI ($17,718 vs. $11,754) over 1 year. A scenario analysis demonstrated that the total cost of care for a cohort of 100 patients at baseline ratio of 30% TAVI versus 70% SAVR was similar to a future scenario, with reverse proportions. While TAVI may seem expensive upfront, when considered as a surgical department budget item, the overall cost to the hospital is comparable to the SAVR.

Reducing Disposable Surgical Items: Decreasing Environmental Impact and Costs at a Children’s Hospital

Reducing Disposable Surgical Items: Decreasing Environmental Impact and Costs at a Children’s Hospital

AORN Position Statement on Managing Distractions and Noise During Perioperative Patient Care

<scp>AORN</scp> Position Statement on Managing Distractions and Noise During Perioperative Patient Care

Blood Loss Estimation in Small Animals and Assessment of a Pictorial Tool to Improve Accuracy in a Global Population of Veterinary Anesthesia Staff.

Visual estimation of blood loss is the most common form of evaluating intraoperative hemorrhage, and is also the most inaccurate. This study investigated the visual estimation accuracy of a global population of anesthesia staff and students as an initial estimation and also with the assistance of a pictorial guide. A voluntary, two-part, online, anonymous survey was distributed to members of two email databases with an interest in anesthesia, including students, nurses, interns, residents, general practitioners, and specialists. The survey consisted of visual and brief descriptive depictions of blood loss scenarios involving small animals, principally including images of common surgical items and receptacles containing a blood-like substance. Each participant estimated the blood volume (in mL) for each scenario twice, initially (Pre-Guide [PGD]) and then with the aid of a pictorial guide (With-Guide [WGD]). The pictorial guide used similar images labeled with corresponding volumes. Data was analyzed for normality with the Shapiro-Wilks test, corrected to absolute error and compared for statistical significance using the Wilcoxon signed-ranks test or the Kruskal-Wallis test as appropriate. The overall raw PGD phase median estimation error was−27 mL (range −99 to 248 mL). The PGD raw median error increased with scenario complexity. There were no differences between role, gender, experience, or country of origin. The overall median raw estimation error for the WGD phase was 13 mL (range −80 ml to 143 mL) (p = 0.0128). Visual blood loss estimation is inaccurate amongst veterinary anesthetists and associated staff, showing decreasing accuracy with increasing complexity. A pictorial guide improves the accuracy generally, and specifically for more complex scenarios which are likely to reflect the clinical situation.

Awareness of Surgical Cost in Gynecology [09B

INTRODUCTION: With the rising cost of healthcare in the United States, recent efforts have focused on reducing healthcare spending without compromising quality and outcomes. Studies have suggested that most surgeons are unaware of the costs related to surgery. The purpose of our study was to assess provider knowledge of the cost of surgical instruments and adjuncts used during gynecologic laparoscopy. METHODS: After IRB approval was obtained, an anonymous survey of practicing gynecologists, OR technologists, and OR nurses at Stony Brook University Hospital was conducted. We inquired about duration of training, formal education regarding cost, self-awareness of cost, and cost estimates for 37 commonly used disposable surgical instruments and items. Similarly to previously published studies assessing cost in other surgical specialties, we defined cost estimate accuracy as within 20% of the hospital cost. RESULTS: A total of 104 surveys were distributed, and 29 complete responses (28%) were received. Of the participants, 17 were attendings, 3 were fellows, 6 were residents, and 3 were OR techs and nurses. On average, participant estimates were within the defined accuracy range for only 13.5% items. There were no differences in accuracy when comparing educational level, years in practice, self-perceived awareness, history of formal cost education, or whether individuals factor in cost. CONCLUSION: Gynecologic surgeons and trainees have poor awareness regarding the cost of the items used during laparoscopic surgery. Providing further education regarding the cost of these items may aid surgeons in making more informed choices and help reduce healthcare costs.

MP60-09 PSYCHOMETRIC TESTING OF A PROM FOR MALE URETHRAL STRICTURE: URETHRAL STRICTURE SYMPTOM AND IMPACT MEASURE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II (MP60)1 Apr 2020MP60-09 PSYCHOMETRIC TESTING OF A PROM FOR MALE URETHRAL STRICTURE: URETHRAL STRICTURE SYMPTOM AND IMPACT MEASURE Bryan Voelzke*, James Griffith, Todd Edwards, Donald Patrick, Keith Rourke, Jeremy Myers, Sean Elliott, Brad Erickson, Alex Vanni, Jill Buckley, Josh Broghammer, Andrew Peterson, Shawn Grove, Anthony Enriquez, and Benjamin Breyer Bryan Voelzke*Bryan Voelzke* More articles by this author , James GriffithJames Griffith More articles by this author , Todd EdwardsTodd Edwards More articles by this author , Donald PatrickDonald Patrick More articles by this author , Keith RourkeKeith Rourke More articles by this author , Jeremy MyersJeremy Myers More articles by this author , Sean ElliottSean Elliott More articles by this author , Brad EricksonBrad Erickson More articles by this author , Alex VanniAlex Vanni More articles by this author , Jill BuckleyJill Buckley More articles by this author , Josh BroghammerJosh Broghammer More articles by this author , Andrew PetersonAndrew Peterson More articles by this author , Shawn GroveShawn Grove More articles by this author , Anthony EnriquezAnthony Enriquez More articles by this author , and Benjamin BreyerBenjamin Breyer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000929.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Urethral Stricture Symptom and Impact Measure (USSIM) is a condition-specific outcome measure for men with urethral stricture. Concept elicitation, cognitive, and prioritization interviews were performed with patients, literature reviews, and clinician interviews to create USSIM content. We describe outcomes following field-testing and assessment of measurement properties for the purpose of creating an outcome measure that is reproducible and able to detect change after treatment. METHODS: A sample of 238 men with urethral stricture was assessed across 9 TURNS centers from 2016- 2018. The USSIM was administered before and 3-9 months after urethroplasty, and it was administered two weeks apart for test-retest reliability. Cystoscopy confirmed urethral patency after surgery. Psychometric analyses included exploratory factor and item response theory analyses. Internal consistency, validity, and test-retest reliability were also analyzed. To assess validity, the USSIM was compared to the only existing stricture-specific outcome measure. RESULTS: Exploratory factor analyses identified an 8-item voiding-related scale and a 3-item sexual function scale. The voiding subscale was highly sensitive to change, t(228) = 23.01, p < .0001, mean reduction = 36.6 on a 0-100% scale (Figure 1). The sexual function subscale was also sensitive to change, t(159) = 5.76, p < .0001, mean reduction = 9.9 on a 0-100% scale (Figure 2). Empirical reliability was .82 and .70 for the voiding and sexual subscales, respectively. Validity coefficients for the voiding scale were rs>= .37 for other measures of voiding symptoms, ps < .0001. Test-retest ICC was .30 for voiding and .56 for sexual items. Following clinical review, the USSIM was reduced: 1 perceived quality-of-life item, 1 surgical outcome item, and 11 other items with urinary and sexual subscales. CONCLUSIONS: The USSIM was psychometrically strong with adequate measurement properties. The reduced version is now being validated for clinical use. Source of Funding: Private donation from Donald Rich © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e892-e893 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bryan Voelzke* More articles by this author James Griffith More articles by this author Todd Edwards More articles by this author Donald Patrick More articles by this author Keith Rourke More articles by this author Jeremy Myers More articles by this author Sean Elliott More articles by this author Brad Erickson More articles by this author Alex Vanni More articles by this author Jill Buckley More articles by this author Josh Broghammer More articles by this author Andrew Peterson More articles by this author Shawn Grove More articles by this author Anthony Enriquez More articles by this author Benjamin Breyer More articles by this author Expand All Advertisement PDF downloadLoading ...

MP83-02 TEAMWORK IN THE OPERATING ROOM: HOW DIFFERENT PERCEPTIONS OF SENTINEL EVENTS MAY NEGATIVELY IMPACT PATIENT SAFETY

INTRODUCTION AND OBJECTIVE:Retained surgical items (RSIs) remain the most frequently encountered sentinel event despite increased vigilance and improved patient safety measures. Recently, a greater...