Going through an extensive surgical procedure, especially one which was done as an emergency, places a massive strain on the body, and it can take a long time to fully recover. Putting your life and wellbeing into the hands of others can be a stressful and anxious time and the reasons for admission to hospital in the first place can take a long time to process emotionally not just for the patient but for their family too. When the patient has to go through the further trauma of realising that the medical staff have left a surgical item inside them, the effects can be very upsetting and long-lasting.
What Is Classified As A Retained Surgical Item?
The office definition of a retained surgical item (RSI) is anything which is left by mistake in a patient’s body during an operation. These items are them further split into categories of soft items (swabs etc), needles, instruments or miscellaneous small items.
Never Events- The Dangers
Given that RSI can result in serious illness or even death for the patient it is classed as a “never event” by both the National Patient Safety Agency and the National Institute for Clinical Excellence (NICE). A “never event” is one which should never be allowed to happen, but this does not mean that there are not incidents of RSI in UK hospitals.
According to studies done in UK hospitals over the last 10 years, it is estimated that somewhere between 4% and 16% of patients in hospital are victims of medical errors. Also, around 1 in every 10,000 operations ends with an RSI incident. Every year the NHS performs upwards of 4 million operations, so you don’t need to be a maths whizz to work out that in the past decade there have been hundreds of RSI incidents. These “never events” shouldn’t happen, but do.
Any incident of RSI is almost always caused by human error by someone on the operating theatre team. There are procedures in place in all hospitals to count all surgical instruments and swabs before the operation begins, count everything used and everything discarded, and to make sure the number at the end matches the number at the beginning. Despite this, items still go astray, and are left inside the patient after the surgeon has finished the procedure, the patient has been stitched up and taken through to the recovery room. Even new technology where swabs are bar coded or scanned with radio frequency readers cannot fully eliminate human error.
If a patient is unlucky enough to leave the operating theatre with something still inside them that shouldn’t be there, the only reason for that is incompetence or negligence on the part of the surgical team as they failed in their basic count. Current NICE guidelines state that a patient should not be taken out of theatre if there is a discrepancy in the “surgical count” of the implements at the beginning compared with what is left at the end. If there appears to be something missing, the protocol is to search the operating theatre thoroughly to try to find the missing object, get an X-ray into theatre to make sure the items are not in the patient, and to re-count everything to make sure the figures are correct.
That protocol is all very well, but it is useless if the count is incorrect to start with, or if the surgical count is carried out incorrectly. A report published in 2003 suggests that this is exactly what happened in a third of the cases which the investigators looked at. Studies carried out in the USA suggest a strong link between an increased frequency of RSI and the tiredness of the operating team, operations done as an emergency and operations where something unexpected happens.
Nature has its own way of flagging up to a patient that something has gone wrong when they are unfortunate enough to be wheeled back to the ward with a piece of surgical equipment still inside them. The patient will become extremely unwell, and could well develop an infection or inflammation either around the area where the implement has been left or more generally. The symptoms experienced by the patient can range from slight discomfort right through to excruciating pain, internal bleeding or losing consciousness. In some cases, it might take months or even years for these symptoms to show.
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