Hunt Regional: A community hospital leads the way in technological innovation

AA patient presents at the hospital for his scheduled abdominal surgery: A resection of the colon. A surgical time out is conducted, general anesthesia is administered, and the patient is intubated and placed on a mechanical ventilator. Sponges are counted by the circulating RN and the scrub person. The surgeon makes an incision, and blood vessels are clamped. The surgery progresses normally but extends through a shift change for the scrub person. At the arrival of the second shift, sudden blood loss occurs, and packs of sponges are rapidly counted into the surgery. As the surgeons focus on identifying the cause of the blood loss, the nurses are also called to order backup blood supply. Once a clamp malfunction is identified, surgery proceeds and is completed. The surgeon is ready for close and is already suturing the patient’s incision. The only problem now is an unreconciled sponge count. The surgery resulted in twice the normal number of sponges, and one is missing. Where is it? Deep within the patient’s abdominal cavity? Was it discarded with the linens? Was the sponge count incorrect? Conducting another count yields the same result. How does the staff know that the in-count was correct? Isn’t that the responsibility of the earlier shift? An X-ray to rule out sponge location in the patient’s abdomen is ordered. While waiting for an update from the radiology department, the nurses search the surgical area, the trash, and the kick-bucket for the missing sponge. Every minute the surgical site stays open is an increased infection risk. The surgeon is aware of this and presses the nurses to call the radiology department again. Due to the blood loss complications, the OR schedule is already off by half an hour. The surgeon and nurses know that OR delays will be brought up by hospital administration during the next OR efficiency meeting. With healthcare costs rising and the added pressures of healthcare reform, every extra minute used in the OR is under scrutiny. The X-ray doesn’t show a sponge. Staff members are confident that the radio-opaque thread would have appeared if the sponge was inside the patient, so the patient is sutured and heals normally. Because the patient doesn’t present to the hospital again with infection or other complications, it’s determined that the sponge wasn’t in the body, but it’s never found. The surgical team discusses the incident at the next patient safety meeting. The question remains: What can be done about this problem?