Bar codes help improve safety in operating room
System helps identify additional miscounts
Researchers at Brigham and Women's Hospital (BWH) in Boston have shown that using bar-code technology to augment the counting of surgical sponges during an operative procedure increases the detection rate of miscounted and/or misplaced sponges. Their research is published in the April 2008 issue of the Annals of Surgery.1
Lead author Caprice Greenberg, MD, MPH, a surgeon at the BWH Center for Surgery and Public Health and the Dana-Farber Cancer Institute Center for Outcomes and Policy Research, and her colleagues found that the bar-code system detected more counting errors than traditional counting methods — both in cases where sponges were misplaced and counted incorrectly. Researchers also report that although the technology introduced new difficulties in the operating room, clinicians felt confident that the technology was effective and easy to use.
"I had done a study in 2002 where we collaborated with experts from human factors engineering to see what had the biggest impact on safety, and we identified communication and workloads with competing tasks," Greenberg recalls. "We found that [sponge] counts were really disruptive to surgical flow. So, we wanted to do an observational study to see what goes on with counts, and if there were any technological solutions out there."
The idea of using bar codes in surgery, says Greenberg, grew out of the success that barcoding technology had in reducing medication errors. It works like this: An individual data matrix code is embedded onto the same sponges the team would otherwise use. They are scanned by a handheld computer before they are put on the operative field and after surgery is completed. "Since each sponge has a unique identifier code, we can not only tell the count, but which one is not accounted for," says Greenberg.
Manual counting vs. 'machine'
The study was a randomized controlled trial funded by Surgicount Medical, the manufacturer of the technology used. A total of 300 patients were studied; 150 were randomized to a traditional manual count and 150 to manual counting with the bar coding as an adjunct.
"We actually identified significantly more miscounts and misplaced sponges," notes Greenberg. The researchers reported that a total of 32 discrepancies were found (miscounted or misplaced sponges) with the second method, but only 13 found using the traditional manual method.
One specific error the scanning system avoids, Greenberg continues, is double-counting sponges. "You can't double-scan a sponge; the system will alert you," she explains. "That's a nice example of how the system can really help."
Members of the surgical team are not yet at the point where they feel comfortable relying totally on the new system, she adds. "They've been counting manually for so long," Greenberg notes. "For now, it should be viewed as an adjunct for counting."
Greenberg says there are a couple of different new approaches to improving surgical safety. "One is bar coding, and then there is also RFID [radio frequency]," she says. "Bar-coding has already been proven to work in meds; as RF technology improves and we learn more about it, it may end up being the one used most, but now both are feasible and commercially available, and a number of institutions are using them."
In fact, Greenberg notes, her team is evaluating two available systems. Meanwhile, she says, "our results are kind of hard to ignore. At this point we are pretty convinced our data show one of these technological solutions should be implemented. "
Reference
- Greenberg C, Diaz-Flores R, Lipsitz SR, Regenbogen S, et al. Bar-coding Surgical Sponges To Improve Safety: A Randomized Controlled Trial. Ann Surg, April 2008; 247(4):612-616.
[For more information, contact:
Caprice Greenberg, MD, MPH, BWH Center for Surgery and Public Health, Boston, MA. Phone: (617) 632-2076.]
Researchers at Brigham and Women's Hospital (BWH) in Boston have shown that using bar-code technology to augment the counting of surgical sponges during an operative procedure increases the detection rate of miscounted and/or misplaced sponges. Their research is published in the April 2008 issue of the Annals of Surgery.1You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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