Greenberg Caprice C, Regenbogen Scott E, Lipsitz Stuart R, Diaz-Flores Rafael, Gawande Atul A
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Ann Surg. 2008 Aug;248(2):337-41. doi: 10.1097/SLA.0b013e318181c9a3.
To prospectively evaluate and accurately describe the rate and type of discrepancies encountered in the surgical count.
Despite near-universal implementation of manual counting protocols for surgical instruments and sponges, incidents of retained sponges and instruments (RSI) persist. Retrospective analyses have shown that RSI are rare and most often involve final counts erroneously thought to be correct, leading some surgeons to question the value of counting. Crucial data regarding how often the surgical count successfully detects meaningful problems before the patient leaves the operating room is lacking.
Trained physician-observers documented prospective field observations during 148 elective general surgery operations using standardized intake forms. Data collection focused on the performance of the counting protocols, and the frequency and outcomes of discrepancies (instances in which a subsequent count does not agree with the previous count).
A mean of 16.6 counting episodes occurred per case, occupying 8.6 minutes per case. A total of 29 discrepancies involving sponges (45%), instruments (34%) or needles (21%) were observed among 19 (12.8%) operations. Most discrepancies indicated a misplaced item (59%) as opposed to a miscount (3%) or error in documentation (38%). Each discrepancy took on average 13 minutes to resolve. Counting activities after personnel changes were significantly more likely to involve a discrepancy than those for which the original team was present.
One in 8 surgical cases involves an intraoperative discrepancy in the count. The majority of these discrepancies detect unaccounted-for sponges and instruments, which represent potential RSI. Thus, despite the recognized limitations of manual surgical counts, discrepancies should always prompt a thorough search and reconciliation process and never be ignored.
前瞻性评估并准确描述手术物品清点中出现差异的发生率及类型。
尽管手术器械和纱布的人工清点规程几乎已普遍实施，但纱布和器械遗留（RSI）事件仍有发生。回顾性分析表明，RSI很罕见，且大多数情况是最终清点时误判为正确，这使得一些外科医生质疑清点的价值。目前缺乏关于手术物品清点在患者离开手术室前成功检测出有意义问题的频率的关键数据。
经过培训的医师观察员使用标准化的录入表格记录了148例择期普通外科手术中的前瞻性现场观察情况。数据收集重点在于清点规程的执行情况，以及差异（后续清点与先前清点不一致的情况）的频率和结果。
每例手术平均进行16.6次清点，每次清点耗时8.6分钟。在19例（12.8%）手术中，共观察到29次差异，涉及纱布（45%）、器械（34%）或缝针（21%）。大多数差异表明物品放置错误（59%），而非计数错误（3%）或记录错误（38%）。每次差异平均需要13分钟来解决。人员变动后的清点活动比原团队在场时的清点活动更易出现差异。
每8例手术中有1例在术中清点时出现差异。这些差异大多检测出未清点到的纱布和器械，它们可能导致RSI。因此，尽管人工手术清点存在公认的局限性，但差异出现时应始终促使进行全面的查找和核对过程，绝不能忽视。
