The annualized cost of searching for missing sponges and ruling out the presence of a retained sponge using radiography was $218,328 at a Level 1 trauma center, according to results of a study presented at the 2015 Surgical Conference & Expo of the Association of periOperative Registered Nurses (AORN).
Additionally, complications of a retained sponge include reoperation, infection or sepsis, readmission/prolonged hospital stay, fistulas/bowel obstructions, visceral perforation and death, according to the poster.
“The processes that are used rely heavily on the surgical count, which involves ongoing management of the sponges during surgery, and is subject to many potential failures,” said investigator Victoria M. Steelman, PhD, RN, CNOR, FAAN, an assistant professor at the University of Iowa College of Nursing, in Iowa City, and immediate past president of AORN.
“The causes of these potential failures include multitasking, distraction and emergent nature of work, which are very difficult to control. Adjunct technology is available to assist with preventing retained surgical sponges, but it does cost more for the sponges. When considering the costs, it is important to look at cost avoidance and the hidden costs of current practices,” she said.
The researchers conducted a retrospective review using data from the health information system of a large, academic medical center. The sample included all patients undergoing surgery in the main operating room (OR) from Feb. 1, 2014 to Oct. 31, 2014. The investigators reviewed 13,322 patient operations and 212 surgical sponge counts required additional time for reconciliation; 88% of these searches resulted in a correct count. The following steps were taken to reconcile counts: sterile field searched, nonsterile areas searched, surgeon notified, wound searched and additional assistance requested.
The cost per minute of operating time was determined using published data ($62 per minute) to enhance generalizability. Because at times surgeons continue with the procedure, and other times redirect their efforts to find the sponge, the researchers conservatively estimated that 50% of the time spent searching for the sponge is nonproductive. Radiology costs of ruling out a retained sponge were also calculated based on published data to maximize generalizability: average radiology costs cited in the literature ($286) and OR time associated with obtaining an intraoperative radiograph (30 minutes).
This novel quantitation shows that the attempts to track down a sponge translate into ineffiencies in the OR, both financially and in terms of distractions that could potentially lead to worse outcomes, said Robert R. Cima, MD, professor of surgery and surgical quality officer at Mayo Clinic, in Rochester, Minn.
“Adjunct technology is an area that institutions should invest in as it has a number of benefits, including standardizing practices and giving a more reliable continuation of the count,” he said. “The improvements that could be made with the addition of new technologies then could have a real effect on patient safety in the OR.”
Dr. Cima added, “This is because the effects are more than just having to do the recount. It actually adds time, it adds more people in the OR and it adds exposure to the patient, all of which increase risk for the patient. When we waste time doing something in the OR that doesn’t add value to the patient and [the] possibility causes harm, then that’s something to look at to eliminate.”
Dr. Steelman said cost of sponge search time should be included in cost analyses when considering adjunct technology to supplement manual counting.