It seems pretty obvious.
When the operating room (OR) team performs a surgery on a patient, the surgeons and nurses shouldn’t leave items in the patient’s body.
As a former hospital administrator, I know that hospital accrediting organizations, such as The Joint Commission, refer to these situations as “never events.” Yet, in my experience, they happen a lot more frequently than you might think. In fact, the medical community has come up with a preferred term, “retained surgical item” (RSI) to try and obscure what they’re talking about. There’s no doubt that the new term sounds better than the more ominous description “retained foreign body.”
The primary responsibility for tracking surgical items and making sure that they’re removed before the surgical site is closed lies with the registered nurse circulator. In fact, the circulating nurse’s main OR role is to keep track of and document surgical items going into and out of the operative field.
But the responsibility doesn’t end there—techs and surgeons share in the responsibility of being careful and paying attention. In addition, hospital administrators and leadership should make sure that operating rooms are supplied with radiopaque gauze, sponges, and towels.
When there’s any question about the surgical item count at the end of a surgery, the standard of care requires the surgeon to order an x-ray. Radiopaque supplies have markers that can typically be seen on an x-ray. Most hospitals use them, but I’ve handled a case involving a major hospital in the Texas Medical Center that stocked its OR with nonradiopaque surgical towels. Guess what? The nurse circulator lost count and one got left inside a patient. It caused another surgery and big problems for the patient.
Even when x-rays are done, though, there's still room for errors.
For example, a Texas radiologist working remotely (outside the hospital, as they frequently do) was asked to review an x-ray image from an abdominal surgery where the sponge count was off.
He looked at the images but couldn’t see a radiopaque marker. The radiologist did the right thing by picking up the phone and calling the OR to learn more about what was going on.
His first mistake was not documenting who he spoke to. The radiologist claimed that he was told that the OR staff had located the missing sponge on the OR floor. Based on that information, the radiologist wrapped up his report by documenting that he found no evidence of a retained surgical item, specifically a retained sponge.
The problem is that the radiologist was wrong.
A week later, the patient, a woman in her 50s, returned to the hospital because of terrible pain in her belly. This time, a CT scan clearly showed the presence of the retained sponge. This required another surgery to remove it, which unfortunately led to additional complications.
In the ensuing litigation, one radiology expert was able to identify a retained sponge on the x-ray, but a second expert could not. In this situation, under the standard of care and practice guidelines published by the American College of Radiology, the radiologist should have written a report that the x-ray image was insufficient to be able answer the clinical question of whether there was a retained sponge. The radiologist should have further recommended another form of imaging, like a CT scan.
If you’ve been seriously injured because of a retained surgical item, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help in evaluating your potential case.
