Surgeons: Man's 'Tumor' Turned Out to Be 25-Year-Old Towel

[BMT (RIP)]

http://www.foxnews.com/story/0,2933,362844,00.html


BMT

[FMF DOC]

Wow.... If that was here there would be a 100 lawyers fighting to get in his room to talk lawsuit....

[Red Flag 1]

if it worth saying, it will be quoted.

[Semper gumby]

Japanese medicine always scared me anyways...I wonder what the heck happened to the towel count. (did they do them in Japan back then, or what?)
We used to get complaints about the local japanese OB doc in Iwakuni, because he would not do any life saving techniques to save the newly born..."was meant to be" was kinda how they thought at the time. Most of the americans wanted to go elsewhere after it happened more than once.

[Red Flag 1]

if it worth saying, it will be quoted.

[Semper gumby]

I seem to remember about a case in the news a couple of years back where a pair of needle drivers were left in the abd. Don't remember much more than that, but I think that it happened here in the US.

[swatsurgeon]

In the non-medical world: to err is human
In the medical would: to err is criminal

Hospitals now have several safety systems in place in the operating room. Some have gone as far as doing an x-ray on every surgical patient (one day IF they ever develop a cancer, a lawyer will blame that single xray as the cause? ).
Remember, this is the perspective of a surgeon...me.

We count all instruments and sponges twice....no 'towels' are brought onto the patient/operative field because they have no radiopaque markers in them.
I generally will hold one of the sponges in my hand...hiding it if you will so that the counts are off by 1 sponge...this accomplishes 2 very important things:
1. if the nurses tell me the count is off by 1, they're correct and that is a great thing and I give back the hidden sponge.
2. if the nurses tell me the counts are correct, we have a huge problem and we then do either re-explore the patient or x-ray the part of the body we were operating on....I STILL HAVE THE HIDDEN SPONGE!! so the count CAN'T be correct.

We go to great lengths to insure safety...just can't deviate from the rules. When surgeons shortcut the system, disaster can happen.

ss

[CPTAUSRET]

In the non-medical world: to err is human
In the medical would: to err is criminal

Hospitals now have several safety systems in place in the operating room. Some have gone as far as doing an x-ray on every surgical patient (one day IF they ever develop a cancer, a lawyer will blame that single xray as the cause? ).
Remember, this is the perspective of a surgeon...me.

We count all instruments and sponges twice....no 'towels' are brought onto the patient/operative field because they have no radiopaque markers in them.
I generally will hold one of the sponges in my hand...hiding it if you will so that the counts are off by 1 sponge...this accomplishes 2 very important things:
1. if the nurses tell me the count is off by 1, they're correct and that is a great thing and I give back the hidden sponge.
2. if the nurses tell me the counts are correct, we have a huge problem and we then do either re-explore the patient or x-ray the part of the body we were operating on....I STILL HAVE THE HIDDEN SPONGE!! so the count CAN'T be correct.

We go to great lengths to insure safety...just can't deviate from the rules. When surgeons shortcut the system, disaster can happen.

ss


Great post!

"Trust, but Verify!"

[Semper gumby]

Hospitals now have several safety systems in place in the operating room. Some have gone as far as doing an x-ray on every surgical patient (one day IF they ever develop a cancer, a lawyer will blame that single xray as the cause? ).



(Also being an x-ray technologist) Unfortunately I've heard of this happening also....The patient claimed that they had developed Cancer from a single Portable X-ray in the ER. The patient dividers at San Diego ER used to be nothing but drapes, and a portable chest x-ray was shot on a patient next door. I'm almost positive that the patient was not successful in his litigation.

Sorry, I digress....

[Doc Dutch]

I was taught as a surgical resident, "Trust no one in the field of surgery". That motto lives with me today. I also was taught to get a post operative x-ray on everyone even if the count is correct because counts can be wrong. Therefore, I get the x-ray before we finish closing. If the radiology tech clips a portion of the chest or abdomen out (the compartment I am working on) then we re-shoot the film. Period. I ask for two counts to be documented, plus the film I have shot. In addition, I have the radiologist call in the room to tell me it is clear. I also look at the film from a monitor in the OR to make sure I agree. The two counts, the radiologist read, and my eyes must be satisified or we do not leave/close the patient until everything says no lap was left behind.

This is the where we are in the world today but I try and make sure that the patient and my team are safe before we leave the OR. The sad truth is that you can save a dying child or police officer and you and your team can look like heroes today, however, once a "lost" laparotomy pad is discovered, you are condemned and the courts will have their way with you as will the insurance companies. They will show you no mercy

Don't be in a rush and triple check your work . . .

MRM

[Odd Job]

Interesting discussion.
We don't X-ray patients post op routinely (to detect swabs) here in the UK. We can't justify the exposure.

However your position in the US is different. It is a different medico-legal environment.
I am curious though: which scenario poses the greater risk to you as a surgeon, in terms of actual accountability for harm to the patient:

1) A swab count that is signed by the circulating nurse or equivalent, that says the count is good, but a swab turns up in the abdomen, undetected (not X-rayed).
2) A patient is exposed to ionising radiation even after the circulating nurse or equivalent has a signed swab count that says the count is good, and no swab is seen on the X-ray.

It strikes me that if the hospital administration bean counters order an audit on this, it will be interesting to see how many positive radiological detections there have been, in the presence of a signed 'good' swab count and whether this can offset a possible class action by those with negative radiographs.

There are all sorts of problems with this kind of thing. It reminds me of the ongoing investigations we have here in the UK to do with the accurate placement of feeding tubes or naso-gastric tubes.
Initially the requirement was that you had to do a Ph test on the aspirate and if that didn't fall within the required range, you had to X-ray it. Some clinicians didn't want to take a chance and reported the Ph as being borderline or high and got their X-ray anyway.

Then somebody reported a case where they had ordered the X-ray, the tube position looked good, but the feed was delivered to one of the lungs nonetheless. There was a fatality.
The current claim according to the NPSA is that the radiograph cannot be correctly interpreted on a screen that doesn't display the required DICOM greys (in other words, you can't use a thin client with a colour screen to make that assessment). That's what we have in most of our theatres and wards, because you can't place a £4,000 Barco monitor on every PACS terminal.

This matter is still not resolved, but over here there is quite a serious drive to reduce the exposure of patients to ionising radiation. Even a wrong exposure or an unnecessary supplementary view generates an incident form.

And like semper gumby says, you get people who will try to pull a fast one and make a claim against the department. One such case that I remember clearly, was a middle-aged woman who came to the department for standard sinus views. These were done on a Schonander skull unit.
The next day the woman came back to the department and wanted to make an official complaint and start a serious investigation into her X-ray examination because she claimed that there had been negligence on the part of the radiographer, which had resulted in her receiving an 'overdose' of radiation. She claimed that the radiographer had first turned the knobs one way and then another, and had looked like he was not sure of the control panel.
When she had got home, she had noticed a rash and flushed feeling and also a general haziness. She claimed she had been given such a high dose of radiation that she was experiencing 'radiation burns.'
That case also didn't get very far, but it caused significant inconvenience, because the radiographer still had to be interviewed and the equipment checked, to make sure there was no anomaly at all that could have influenced this patient's examination.

[RichL025]

I generally will hold one of the sponges in my hand...hiding it if you will so that the counts are off by 1 sponge...this accomplishes 2 very important things:
1. if the nurses tell me the count is off by 1, they're correct and that is a great thing and I give back the hidden sponge.
2. if the nurses tell me the counts are correct, we have a huge problem and we then do either re-explore the patient or x-ray the part of the body we were operating on....I STILL HAVE THE HIDDEN SPONGE!! so the count CAN'T be correct.

ss

Great plan, until the scrub or the circ nurse remembers about your penchant and starts factoring that in <g>.

One of the hospitals we rotate at takes post-op Xrays of EVERY patient. But... no one reviews the xray before the patient leaves the OR... so in the unlikely event that a radiologist catches a needle or sponge in the belly (and needles are pretty damn tiny on those plain films) a day or so later... what do you do? Take the patient back for a routine re-exploration? Tell the patient about it so if it ever causes him problems he can be re-explored (boy, we could discuss the pros & cons of THAT one for a week without even involving the legal aspects)?

[Mangoose]

sorry, this is in the wrong thread