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5 Technologies to Make Surgery Safer

 |  By gshaw@healthleadersmedia.com  
   August 31, 2010

Low-tech solutions such as checklists and calling a time-out before surgery can dramatically improve safety in the operating room, according to the American College of Obstetricians and Gynecologists (ACOG), which recently released guidelines to deter surgical errors. But there are plenty of technologies that can help make the OR a safer place—from systems that keep track of sponges and to robots that may someday be able to deliver anesthesia remotely to systems that help counteract alert fatigue.

The ACOG guidance supports the Joint Commission's "three-part universal protocol" as a useful tool for healthcare teams to prevent surgical errors. The first protocol calls for the healthcare team to ensure that each patient's relevant documents and all of the surgical equipment are available, correctly identified, and reviewed before surgery."Using standard checklists, systems, and routines may sound to some like cook-book medicine, but they have been proven to greatly reduce surgery errors," said Richard Waldman, MD, ACOG's president.

The steps sound simple—and they are. And yet surgical errors still occur. The steps endorsed by ACOG rely heavily on humans to perform them, after all. And human behavior, human actions, and human memory are far from perfect.

Here are five surgical pitfalls and the technology that can help humans in the OR avoid them.

1. Retained surgical instruments
The FDA recently approved another surgical tool tracking system that helps keep all manner of surgical implements, including sponges, where they belong—namely, outside of the patient's body. There are a number of these systems, which keep track of every item in the room through RFID chips and alert OR staff when one is not in its proper place. Some systems have a wand that, when waved over the patient's body, detect any items left behind. These systems help cut down on complex and time-consuming counting procedures that are prone to human error.  

More than a third of all retained surgical items are instruments (52% radiopaque sponges and 43% instruments), according to a 2007 study in the Journal of Surgical Research. Correcting such errors adds about $2 billion each year to the nation's medical bill.

2. Wrong-site surgeries
Wrong-site surgeries, an alarming surgical error that sometimes inspires patients to draw on their bodies with magic markers (“THIS LEG, PLEASE!”) could be reduced with better access to data. Charts can get mixed up, but a new  portable biometric-activated data card that stores patients' personal medical information could be a solution to that problem. It doesn't work unless the patient first scans his or her fingerprint on the card itself. Only after the finger is verified can physicians view the data. It's the size of a credit card, but it can hold gigabytes of data, including full EKGs, complete CT scan images, and digital MRI images.

3. Healthy tissue damage
Technology could prevent complications that aren't caused by human error, as well, including damage to normal, healthy tissue. A new electrosurgical device aids surgeons by selectively targeting diseased cartilage tissue during procedures. Its design, which combines low RF energy delivery with a protected electrode (to avoid electrode-to-tissue contact), allows for localized treatment of damaged/fibrillated cartilage tissue while avoiding harm to healthy cartilage.  

4. Lack of access to anesthesiologists
Improper anesthesia administration is another scary medical error—and one that particularly affects patients in rural areas or areas with shortages of anesthesiologists. Experts could administer regional anesthesia from afar with the help of a surgical robot, according to a study in the September issue of Anesthesia & Analgesia. In the study, both single-injection and perineural catheter techniques were successfully performed by an operator who was not physically present at the bedside by placing ultrasound-guided nerve blocks into an ultrasound phantom using a surgical robotic system. “Similar advances in teleanesthesia will be necessary to bring comparable perioperative care to the geographically remote patient,” the authors note.

5. Alert fatigue
Clinicians and caregivers can become overwhelmed by alarms to the point that they start to tune them out—it's common enough that there's a term for it: alert fatigue. An alarm management system that can differentiate between serious alerts and less pressing matters works on top of pulse oximeters, which monitor patients for oxygen saturation levels after surgery. The system prioritizes the importance of these alerts and only notifies the nurse about the most pressing. It doesn't just alert to drastic drops, but also to the more subtle—and easier for humans to miss—recurring moderate reductions in airflow. The system also provides the clinician with historical and real-time information about a patient's condition.

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