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What if your doctor left surgical instruments inside you?

Madura McCormack | Oct. 24, 2012
KK Women's and Children's Hospital addresses the flawed system with technology

Twelve days after a routine Caesarean section, Shweta Khandel was rushed for emergency surgery after complaining of severe abdominal pain. Together with the two litres of pus they removed from her "dangerously" swollen belly, doctors at St Stephens Hospital in New Delhi India also extracted the gauze that had been negligently left behind.

With the high risks involved in surgery and the potential life-threatening consequences of human error, somehow the method of manual tracking of surgical instruments by nurses remains unchanged.

"Day after day, our surgical team will have to do this manual counting. I've always wondered about our colleagues in other industries, for example bank tellers have cash counters to minimise error, go to a supermarket and cashiers have barcode scanners that scan all your items without you having to go through manual processes, yet in the operating theatre, for years, nothing has changed," said Associate Professor Bernard Chern, head and senior consultant in the department of obstetrics and gynaecology at KK Women's and Children's Hospital.

"So we started with a very simple request, I asked my team, can we get a counting machine so our nurses don't have to do this tedious process [of manually counting gauze and instruments]," Chern added.

That request evolved into a full scale project involving multiple departments of KK Women's and Children's Hospital (KKH).

The objective was simple, minimise human counting error and subsequently reduce the risk of gossypiboma.

SCOTT

Surgical Counting and Operating Theatre Tracking or SCOTT, the first of its kind and wholly designed and developed in Singapore, tracks and locates the movement of gauze and surgical instruments as they circulate around the operating theatre.

By incorporating RFID tags into swabs and instruments and fully integrating the system into the workflow of the operating theatre, the system reduces errors from manual counting.

Gracefully simple and intuitive, the SCOTT system counts gauze in its RFID detector bin and inputs the information onto the system. Counting of gauze over a few stages in surgery that took about 15 to 30 minutes were reduced to five with incorporation of the system, according to KKH

"The gauze may look white, but when it goes into the body it looks like a clump of blood. This is why it's easy to misplace or leave behind," Chern explained.

When the system detects a discrepancy in the before and after counts of the RFID tagged gauze, an alert appears on the monitor. Armed with a handheld RFID scanner, surgical staff will skim over the patient to locate the missing instrument.

What the future holds

In clinical trials since July 2010, SCOTT has yet to be approved for widespread use by the Health Sciences Authority (HSA) though KKH hopes to one day see the national rollout of the system.

 

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