Improving Clinical and Financial Results with Better Detection

Not every hospital executive has insight into everything that happens in their ORs, but what transpires there can often make or break a hospital's reputation and bottom line.

A retained surgical sponge, which happens approximately 27 times each week* in the U.S., for example, not only results in negative press coverage and extra scrutiny from regulatory bodies due to compromised patient safety, it also often comes with legal defense costs, malpractice settlements, reimbursement loss and state penalties.⁸ The lack of awareness around highly effective technology and processes that can help prevent these “never events” is causing providers to risk both patient safety and financial savings.

In a recent survey of 291 healthcare professionals conducted by Modern Healthcare Custom Media, more than half of the respondents believe a retained surgical sponge incident happens as often as once in every 200 procedures,³ and 44 percent acknowledge they have experienced an event in their organization in the past three years.³ Yet, 55 percent stated they were unsure how much these incidents cost their organization.³

It is estimated that a retained surgical sponge event can cost an institution more than $450,000,¹² due to legal defense, settlements and reimbursement losses. This does not include the cost of using OR time and X-ray to rule out the presence of retained surgical sponges, which is estimated to be $219,056 annually.¹³ Interestingly, 49 percent of survey respondents were unsure how much their organization spends on X-ray annually to detect a possible retained surgical item.³

The most popular method being used for retained surgical sponge prevention is pre- and post-procedure counting of instruments and sponges.³ Fifty-seven percent of survey respondents report using X-ray, as well.³ Additionally, 31 percent of those surveyed combine using pre- and post-surgical counting and X-rays as a fail-safe,³ which has significant flaws:

• It's not always possible. In emergent events from gunshot wounds to heart attacks, there is rarely time or opportunity to stop and get an accurate count.¹⁸
• Humans make mistakes. Someone can count wrong. A miscount occurs once in every 64 procedures.¹⁴ For a hospital with a 10,000-surgery volume annually, that leads to 52 hours of wasted OR time reconciling miscounts.¹⁵ Human error leads to additional protocols, typically X-ray.
• Using X-ray to detect RSIs is effective only 67 percent of the time.¹⁶ Oftentimes it's not just that the X-ray doesn't pick it up, it's that the radiologist isn't aware of what may have been retained.

RF technology is far more accurate—at 100 percent sensitivity and specificity¹⁷—in detecting retained sponges, even in the most special cases and in patients with a high BMI, up to 82.¹⁵ It works by using RF-tagged sponges and a body scanner to allow for quick, effective resolution of miscounts,⁸ saving hours of wasted time, possible second surgeries and a host of other negative consequences related to a retained sponge event.⁸ The annual cost of implementing retained surgical sponge RF technology is about $191,352, far outweighing the costs of a retained surgical item event.⁸

“Hospital administrators and executives are currently investing in technologies that are not 100 percent effective, which still leaves them vulnerable to a very common event that can have a disastrous impact on an organization,” said Dr. Lawrence Lottenberg, Director of Trauma Research and Education at St. Mary's Medical Center in West Palm Beach, Fla.¹⁹ “Retained surgical items, particularly retained sponges, actually happen often and proactive measures must be taken in order to save patient lives, while relieving unnecessary financial burdens on organizations and the healthcare industry as a whole.”

There is also a disconnect around provider executives' perceptions of preventing these adverse events. In the survey, 85 percent said they consider their organizations to proactively approach adverse events through prevention and processes,³ with 12 percent saying their organizations are reactive.³ Yet, only 16 percent are using RF detection technology.³

RF technology comes at a crucial time, as payers are capping and bundling payments, requiring providers to take on the financial risk for clinical outcomes. A technology that is proven 100% sensitive and specific for detection of retained surgical sponges should undoubtedly be considered.

For more information on Medtronic Situate™ and these survey results, visit

medtronicsolutions.medtronic.com/situate.

Footnotes

1. Mehtsun et al. Johns Hopkins Report, 2013.
2. Gawande et al. N Engl J Med, 2003.

Medtronic/Modern Healthcare Custom Research, Nov 2016. Email Survey of 291 healthcare professionals, inclusive of clinical management, case management, senior management, financial management, materials management, operations management and general administration representatives.

3. Calculation based on occurrence of RSIs per week (39 times per Mehtsun et al. Johns Hopkins Report, 2013) and then 69% of RSIs being sponges (Gawande et al. N Engl J Med, 2003).
4. Dr. Glenn Ault was interviewed by Modern Healthcare in December 2016 to discuss the survey results.
5. Steelman et al. AORN Presentation, March 2015.
6. Gawande et al. N Engl J Med, 2003.
7. Cima et al. N Engl J Med, 2003.
8. Steelman, Amer J Surg, 2011.
9. Williams TL. et al. JACS 2014 (page 360) Total costs of RSI incident estimated at $441,534.
10. NOTE: Amounts based on data provided in below four sources and comparison to counting methodology. Calculations based on an occurrence of 1 in 7,000 procedures, assuming 10,000 procedures annually:

    • 1. Stone PW, Braccia D, Larson E. Systematic review of economic analyses of health care-associated infections. American Journal of Infection Control 2005;33(9):501–509. doi:10.1016/j.ajic.2005.04.246. 2. Carroll AE, Parikh PD, Buddenbaum JL. The Impact of Defense Expenses in Medical Malpractice Claims. The Journal of Law, Medicine & Ethics, Spring 2012:135–142.. 3. Fact Sheet: CMS Proposes Additions to List of Hospital Acquired Conditions for Fiscal Year 2009. www.cms.gov 2008. Available at: http://www.cms.gov/newsroom/mediareleasedatabase/factsheets/ 2008factsheetsitems/ 20080414. html#_ftn3. Accessed June 2015. 4. Lincoln, Taylor. Malpractice Payments Sunk to Record Low in 2011: Skyrocketing Healthcare Costs and Rampant Medical Errors Discredit the Promises Put Forth by Advocates of Tort Reform. Public Citizen, July 2012.

11. Steelman et al. AORN Journal, November 2015. (Page 498).
12. Steelman et al. AORN Presentation, March 2015.
13. NOTE: Amounts based on data provided in below four sources. Calculations based on an occurrence of 1 in 64 procedures, assuming 10,000 procedures annually.

    • 1. Steelman et al. AORN Presentation, March 2015.
    • 2. Egorova et al. Ann of Surg, 2008.
    • 3. Macario. J of Clin Anesth

14. Cima et al. N Engl J Med, 2003.
15. Steelman, Amer J Surg, 2011.
16. Williams TL. et al. JACS 2014 (page 360).
17. Inaba K, Okoye O, Aksoy H, et al. 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. 2016 July 18.
18. Dr. Lottenberg was interviewed in December 2016 for commentary on the results of the Modern Healthcare survey.