Positive control radiographs can help limit retained surgical items

Retained surgical items – tools and implements left inside a patient’s body after a procedure – put patients in danger and can cost providers a fortune in legal fees and non-reimbursed healthcare costs. Positive control radiographs can help radiologists locate these items before it’s too late, according to a study by Kristin Kelly Porter, MD, and colleagues in the Journal of the American College of Radiology.

Retained surgical items are considered a “never event,” because they should never occur, but 772 such incidents were reported from 2005 to 2012, and 16 of those incidents resulted in the patient’s death. The authors pointed out that these statistics come from volunteered information, so the actual numbers could actually be higher.

Surgeons do perform manual sweeps to check for retained surgical items, and nurses make instrument counts before and after the procedure, but these strategies do not catch everything, the authors wrote. Radiologists are often brought in to help when a retained surgical item is suspected, putting pressure on them to quickly identify the item.

To help save time and put less stress on radiologists, the authors experimented with automatically providing positive control radiographs when a retained surgical items was suspected.

“This policy was implemented after a fellow failed to identify a sponge because he was unfamiliar with the appearance of the sponge marker,” Porter et al wrote. “Inclusion of a positive control radiograph mitigates the necessity of cutting-edge familiarity with the appearance and nomenclature of all surgical instruments and devices.”

The policy was viewed as an immediate success.

“A controlled trial of the positive control radiograph was not performed, because its implementation was met with an overwhelmingly positive response,” Porter et al wrote. “Communication errors are avoided, as both surgeons and radiologists use the same nomenclature for the missing item: ‘positive control.’”

The authors wrote that this added step helps radiologists interpret scans, reduces patient harm, and improves both patient and clinical outcomes. It also helps keep health care costs from rising due to lengthened anesthesia time or delayed surgeries.

“A control radiograph should be included with every intraoperative radiograph for a suspected missing surgical item,” Porter et al wrote.