Damages from left-behind surgical tools top billions as systems seek end to gruesome errors

While surgical screws or sponges can cost a hospital less than a penny each, when a surgeon accentially leaves one of these behind in a patient's body the mistake can cost both patientsa and healthcare providers dearly.

According to Nate Miersma, director of Stryker, a medical device and equipment manufacturer, that the financial impact for one instance of surgical retention can add up to around $600,000 including legal costs and the cost of corrective surgery to remove the item.

Retained surgical instruments occur once in every 5,500 surgeries, said Miersma, and almost 70 percent of the items left behind are sponges. The annual cost to healthcare systems is about $2.4 billion.

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"They're very easily lost within the surgical cavity," he said. "They're white, but as soon as they're soaked with blood it matches perfectly, just like a chameleon, inside the surgical cavity. It's very easy to misplace one and not know that it's in there. Gauze material conforms to the anatomy."

To avoid a big monetary hit, some hospitals and health systems have adopted a new approach to their item counts.

Companies like Stryker and others have spearheaded a technology that essentially embeds an identifying barcode on each of its sponges, making it easier to keep track of how many are being used in the operating room -- and whether any have been left behind.

Valerie Marsh, RN, MSN, of the University of Michigan Health System, said the barcode technology has been extraordinarily beneficial at her hospital -- which, like most systems, conducts its instrument counts manually.

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"You always do three counts," said Marsh. "A baseline count, anything you add to the field is also counted, and at the end of the case you do a final count. (But) there's a lot of circumstances that can cause a retained sponge. It could be the lack of a policy, or it could be poor communication or inadequate education from a provider's point of view. From a patient perspective, it could be if they have a higher (body mass index)."

Either way, she said, when the count is performed manually, it leaves the door open for simple human error. And in up to 88 percent of cases involving surgical retention, the count was erroneously shown to be correct.

What makes a missed count even trickier for a hospital, said Marsh, is that it's a non-defendable error, or a "never event." Nationally, between 2007 and 2011, there were 320 medical malpractice lawsuits for surgically retained items, with an average pay of $125,000 to the patients.

Since implementing the barcode technology on its surgical sponges, the University of Michigan Health System has been able to double-check the human count against the electronic count, and with sterling results: The system hasn't seen a single surgically retained item since implementation.

"Most errors in healthcare are due to human factors," said Marsh. "It's like aviation -- if you don't do these checks, there can be human errors that happen. That's why we put these standard practices in place. You follow the same process every single time, because then you can say, 'We never, ever vary from this practice.'"

Don Owens, divisional director of surgical services at Medical Center Hospital in Odessa, Texas, pursued similar sponge barcode technology after his hospital experienced three retained sponges in one year.

"We were like, 'Oh my gosh, we've got to do something,'" said Owens. "At some point the patient would get really sick and start having abdominal pain. They'd end up doing an X-ray and saying, 'There goes a retained sponge. We've got to go back to the operating room.' That can be pretty traumatic for someone. I had an appendectomy a few years ago, and if someone had come up to me and said, 'We have to go back on in,' oh my God, I would have died."

The new sponges, called SurgiCount, are more expensive than regular sponges, he said. "But they're less expensive than a retained item. That's the way we looked at it: The cost of something retained would be much higher. It's also better patient care. It's not just about cost, but the trauma and inconvenience to a patient."

From a patient safety perspective, cutting down on the instances of retained sponges is huge, said Miersma, because sponges are more harmful to the body than other instruments. Metal implements are typically made with surgical steel, which is biocompatible, so the body doesn't reject them. Sponges are not biocompatible, and so the body actively tries to expel them; according to Miersma, over 16 percent of those who are left with a sponge in their surgical cavity experience some form of permanent injury. About 4.5 percent die.

Quantifying the exact cost savings for a health system can be challenging, said Miersma, because the topic of surgically retained items is still taboo, and reporting is spotty.

"Retained items happen 11 times a day," he said. "Everyone acknowledges there's a problem, but nobody wants to acknowledge the specific problems at their facility -- liability, the costs associated. It's very difficult to track the reduction in costs to one individual healthcare provider simply because the statistics aren't shared."

Still, those who've made the switch say they're happy with the results.

"We've never regretted it, and we would never go back," said Owens.

Twitter: @JELagasse