5 0 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E O C T O B E R 2 0 1 6
and sometimes they're intentionally packed into small spaces to provide pressure
and absorb fluid." As a result, sponges are the most commonly left-behind item.
That's where the counting done by nurses and scrub techs is supposed to save the
day. But nurses and scrub techs are multitasking. They're also only human. "We've
all had the experience of counting a deck of cards and getting 53 when we know it's
really 52," says Dr. Regenbogen.
OR staff must also depend on manufacturers to always have the right number of
sponges in every package. That doesn't always happen.
So ultimately an incorrect count is no guarantee that a missing sponge is in the
patient. It may be in the drapes, or the trash, or it may be stuck to another sponge.
And a "correct" count is no guarantee that one hasn't been left behind. In fact, it's
those correct counts that more often turn out to be problematic. "It makes sense,
because as surgeons, when we have an incorrect count, we go to the end of the
earth looking for that sponge," says Dr. Regenbogen. "But if the count is correct,
we're generally satisfied, and we end the operation."
Trust, but verify
A clinical study conducted several years ago by Dr. Regenbogen and colleagues
determined that over time, systems that involve scanning barcoded sponges pay for
themselves (osmag.net/zx5yxb). "They appear to be effective enough to reduce the
incidence of retained sponges to a near negligible level," he says. At the University
of Michigan, where Dr. Regenbogen practices, scanning barcoded sponges is now
standard, but nurses still count. He says, "It's partly a testament to their dedication,
but it's also a measure of the fact that we don't quite trust technology to do it all."
Staff at the University of Michigan don't leave the OR until both types of counts
have been resolved. "If there's a discrepancy in counting, but the bar code says we
have every sponge, we recount," says Dr. Regenbogen.
There are occasionally going to be unresolved discrepancies no matter what tech-
nology you use. The important thing is to make sure that missing sponge isn't inside
the patient. "I don't know of a (retained-sponge) event in the 5 years since we start-
