Ignite Creation Date:
2024-05-05 @ 4:39 PM
Last Modification Date:
2024-10-26 @ 9:22 AM
Study NCT ID:
NCT00282750
Status:
COMPLETED
Last Update Posted:
2010-01-14
First Post:
2006-01-26
Brief Title:
The Bar Coded Sponge Study
Sponsor:
Brigham and Womens Hospital
Organization:
Brigham and Womens Hospital
Study Overview
Official Title:
A Randomised Clinical Trial of a Bar-Coded Safety Sponge System
Status:
COMPLETED
Status Verified Date:
2010-01
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
The purpose of this study is to test whether bar coded surgical sponges can significantly increase the safety of operations specifically by 1 reducing discrepancies and miscounts 2 reducing total staff time spent on sponge counting and 3 reducing disruptions to the operating room as a system Also the study aims to further characterize the limitations of the current surgical sponge counting protocol
Detailed Description:
Prior work by Dr Gawande showed that the incidence of a retained foreign body is between 1 in 9000 and 1 in 19000 inpatient operations or at least once a year for a hospital of any size Leaving foreign objects in body cavities after surgery can lead to infection bowel obstruction and in some cases death The current approach to preventing this problem is based on adherence to a counting protocol to check the number of instruments and sponges at the beginning and end of the case The problem of retained foreign body is often attributed to error in the counting process-for example in the case of a retained object count totals at the beginning and end of the case can be erroneous if an item was not initially counted or if an item was double- counted at the end of a case In addition to this potential for incorrect counts the counting protocols can lead to disruptions in case flow and inefficiencies
In an observational study of surgical performance which brought human factors experts into Brigham and Womens Hospital operating rooms to examine 10 complex cases counting protocols for tracking instruments and sponges in particular played a surprisingly negative role on team performance After the incision was made nurses devoted an average of 35 minutes to the counting protocols This represented 145 of the operative time During this time the investigators were able to document substantial negative effects on surgical work while the nurses were involved in the counting protocol Furthermore a counting discrepancy was observed to occur in two-thirds of the cases with a total of 17 discrepancies in 9 cases As a result in several patients progress of a still-incomplete operation had to be substantially delayed or suspended while the nurses attempted to reconcile inconsistencies
Based on these 2 studies we conducted a rigorous search and innovation process generating five possible technologies to detect when instruments or sponges are left behind Discussions with engineers and a focus group of operating room nurses identified two of these technologies as most feasible for adoption 1 bar-coded sponges and 2 a computer vision system for tracking instruments
SurgiCount Medical which has subsequently joined Patient Safety Technologies both of Los Angeles has designed the Safety-sponge System which utilizes bar-coded sponges and is now available for testing The 4 x 4 X-ray detectable gauze sponges and 18 x 18 X-Ray detectable laparotomy pads are manufactured in the same fashion as sponges currently used today They contain the X-ray detectable strip that can identify a retained sponge on a plain X-ray A unique bar code data matrix code has been securely affixed to each sponge The datamatrix code with ECC200 error correction allows for accuracy up to 1 error in 105 million worst case 1 in 6129 million best case FDA 510K exemption status for the bar coded sponge has already been secured by the manufacturer The bar code detector sponge counter has been designed as a small handheld computer with a touchscreen display
Before introducing new technology into a healthcare system it is important to study the effect that technology will have on the system This includes both whether the new technology has the desired effect but also whether there are any unintended negative effects Our pre-clinical simulations suggest that the Safety-Sponge System has the potential to improve safety and efficiency in the operating room and other hospitals are moving ahead with purchase of the system However we argue that the benefit must be proven in a randomized trial comparing it to the traditional counting protocol
If our hypothesis is correct this technology could revolutionize the counting procedures and improve both safety and efficiency in the operating room This could decrease the risk of retained foreign bodies for patients In addition it could decrease the workload for the nursing staff in the operating room leading to improvements in their working conditions and the overall safety of the system
Comparisons patients will be randomized to one of two equal groups usual counting protocol versus bar-code technology assisted counting
In an observational study of surgical performance which brought human factors experts into Brigham and Womens Hospital operating rooms to examine 10 complex cases counting protocols for tracking instruments and sponges in particular played a surprisingly negative role on team performance After the incision was made nurses devoted an average of 35 minutes to the counting protocols This represented 145 of the operative time During this time the investigators were able to document substantial negative effects on surgical work while the nurses were involved in the counting protocol Furthermore a counting discrepancy was observed to occur in two-thirds of the cases with a total of 17 discrepancies in 9 cases As a result in several patients progress of a still-incomplete operation had to be substantially delayed or suspended while the nurses attempted to reconcile inconsistencies
Based on these 2 studies we conducted a rigorous search and innovation process generating five possible technologies to detect when instruments or sponges are left behind Discussions with engineers and a focus group of operating room nurses identified two of these technologies as most feasible for adoption 1 bar-coded sponges and 2 a computer vision system for tracking instruments
SurgiCount Medical which has subsequently joined Patient Safety Technologies both of Los Angeles has designed the Safety-sponge System which utilizes bar-coded sponges and is now available for testing The 4 x 4 X-ray detectable gauze sponges and 18 x 18 X-Ray detectable laparotomy pads are manufactured in the same fashion as sponges currently used today They contain the X-ray detectable strip that can identify a retained sponge on a plain X-ray A unique bar code data matrix code has been securely affixed to each sponge The datamatrix code with ECC200 error correction allows for accuracy up to 1 error in 105 million worst case 1 in 6129 million best case FDA 510K exemption status for the bar coded sponge has already been secured by the manufacturer The bar code detector sponge counter has been designed as a small handheld computer with a touchscreen display
Before introducing new technology into a healthcare system it is important to study the effect that technology will have on the system This includes both whether the new technology has the desired effect but also whether there are any unintended negative effects Our pre-clinical simulations suggest that the Safety-Sponge System has the potential to improve safety and efficiency in the operating room and other hospitals are moving ahead with purchase of the system However we argue that the benefit must be proven in a randomized trial comparing it to the traditional counting protocol
If our hypothesis is correct this technology could revolutionize the counting procedures and improve both safety and efficiency in the operating room This could decrease the risk of retained foreign bodies for patients In addition it could decrease the workload for the nursing staff in the operating room leading to improvements in their working conditions and the overall safety of the system
Comparisons patients will be randomized to one of two equal groups usual counting protocol versus bar-code technology assisted counting
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None