Dr. Marsh agrees: "Staff members have to use it
correctly. They can't take shortcuts. Sometimes
everybody's rushing, and they're trying to get to the
next case, and the barcode count may be forgotten
or not done. Then the patient is out of the room and
they realize, 'We don't have all our sponges.'"
Does the counting technology extend surgical or
turnover times? The advocates we spoke to it does-
n't. "This is all done during the case," notes Dr.
Cima. "When we begin to close the patient, the
nursing team is already counting sponges. We have
not been able to attribute counting of the sponges
using the technology to any increases in the
duration of the case.
"If you drop this technology into the OR without
setting the stage and working it into the standard
workflow, it's not going to work," he continues.
"This is an adjunct to reinforce with our staff the
appropriateness of their manual process."
Counts still matter
Proponents of sponge counting and detection sys-
tems stress they're not meant to be replacements
for manual counts, but rather to provide confirma-
tion and reassurance that the manual count was
correct. "You perform the surgery, and prior to
close, you count, and then you wand the patient,
because counts can be incorrect," says Ms.
Langerman, who reports the wand can find sponges
at least 18 inches deep.
How often does the wand find a sponge? "The
percentage of retained objects is very low," she
says. "We haven't found anything within a patient.
However, if I've done a final count and I can't find a
sponge and know it's not in the patient, I've wanded
trash looking for sponges."
Dr. Marsh agrees her institution's barcode-
based system isn't a replacement for manual
counts. "We made it a tool," she explains. "The
process is the same, except now it's computer
technology that's recording the information. The
reason we need the technology is because we're
human, and we make mistakes."
In addition to peace of mind, however, the
technology also provides a record that goes
beyond paper charting.
Dr. Marsh says this can be crucial in a case
where, for example, a surgery took place at your
facility and then a sponge is retained when the
patient undergoes another procedure somewhere
else. "If they come back to us and say, 'You left the
sponge from the original surgery,' we can pull that
case's record and say, 'No, we closed our count out
before the patient left the room,'" she says. "All we
had before was our paper chart that said, 'We
counted together, and the count was correct.'"
Dr. Cima notes another attractive byproduct of
the technology: It removes a frequent bone of con-
tention. "The biggest issue has always been when
the nurse says the sponge count is off, and the sur-
geon says, 'Well, it's your responsibility, count
again,'" he says. Now the nurse says, 'The machine
says we're off by one,' and once they say that, the
surgeon's got to look for the sponge."
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RARE BUT DEVASTATING These 2018 images show how a woman suffering for years from abdominal bloating had two retained sponges from a prior surgery.
