Kaplan Harrison J, Spiera Zachary C, Feldman David L, Shamamian Peter, Portnoy Bonnie, Ioannides Paula, Leitman I Michael
From the Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (Kaplan, Spiera, Portnoy, Leitman).
Healthcare Risk Advisors, TDC Group of Companies, New York, NY (Feldman).
J Am Coll Surg. 2022 Sep 1;235(3):494-499. doi: 10.1097/XCS.0000000000000264. Epub 2022 Aug 10.
Retained surgical items (RSIs) are rare but serious events associated with significant morbidity and costs. We assessed the effectiveness of radiofrequency (RF) detection technology and Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in reducing the incidence of RSIs.
All RSIs reported to the New York Patient Occurrence Reporting and Tracking System at five large urban teaching hospitals from 2007 to 2017 were analyzed. In 2012, TeamSTEPPS training was provided to all perioperative staff at each site, and use of RF detection became required in all procedures. The incidence of events before and after the interventions were compared using odds ratios.
A total of 997,237 operative procedures were analyzed. After the interventions, the incidence of RSIs decreased from 11.66 to 5.80 events per 100,000 operations (odds ratio [OR] [95% CI] = 0.50 [0.32 to 0.78]). The frequency of RSIs involving RF-detectable items decreased from 5.21 to 1.35 events per 100,000 operations (OR [95% CI] = 0.26 [0.11 to 0.60]). The difference in RSIs involving non-RF-detectable surgical items was not statistically significant.
The incidence of RSIs was significantly lower during the time period after implementing RF detection technology and after TeamSTEPPS training, primarily driven by a decrease in retained RF-detectable items. RF detection technology may be worth pursuing for hospitals looking to decrease RSI frequency. The benefit of TeamSTEPPS training alone may not result in a reduction of RSIs.
手术遗留物品（RSIs）虽罕见但后果严重，会导致显著的发病率和成本。我们评估了射频（RF）检测技术和团队策略与工具以提高绩效和患者安全（TeamSTEPPS）在降低RSIs发生率方面的有效性。
分析了2007年至2017年期间五家大型城市教学医院向纽约患者事件报告和跟踪系统报告的所有RSIs。2012年，每个地点的所有围手术期工作人员都接受了TeamSTEPPS培训，并且所有手术都要求使用RF检测。使用优势比比较干预前后事件的发生率。
共分析了997,237例手术。干预后，RSIs的发生率从每100,000例手术中的11.66例降至5.80例（优势比[OR][95%置信区间]=0.50[0.32至0.78]）。涉及可RF检测物品的RSIs频率从每100,000例手术中的5.21例降至1.35例（OR[95%置信区间]=0.26[0.11至0.60]）。涉及不可RF检测手术物品的RSIs差异无统计学意义。
在实施RF检测技术和进行TeamSTEPPS培训后的时间段内，RSIs的发生率显著降低，主要是由于可RF检测遗留物品的减少。对于希望降低RSI频率的医院来说，RF检测技术可能值得采用。单独的TeamSTEPPS培训的益处可能不会导致RSIs的减少。
