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Friday, January 17, 2003Overall, the retention of a foreign body was a rare event. The incidence varied from 1 in 8801 to 1 in 18,760 inpatient operations at the nonspecialty acute care hospitals (the four principal hospitals and one other) insured by CRICO for which complete data on inpatient operations and claims and incident reports on retained foreign bodies were available throughout the period from 1990 through 2000. The 1500 per year figure comes from this unfortunate extrapolation: Overall, our results suggest that, given the 28.4 million inpatient operations performed nationwide in 1999, more than 1500 cases of a retained foreign body occur annually in the United States. It isn’t really valid to apply the findings of a small group of physicians and hospitals in one state to the entire nation. Nor is it valid to extrapolate data gathered from 1985 to 2001 to to all surgeries performed nationwide in 1999. From 1985 to 1999 there has been an explosion in surgical technology. Surgeries that were once routinely performed by opening the abdomen, such as gallbladder surgery and appendectomies were routinely done with laparoscopic techniques by 1999. Laparoscopes require only small incisions and the insertion of fiberoptic scopes into the abdomen. It would be extremely hard to leave behind a sponge or an instrument in those. The paper doesn’t reveal in what years their retained instrument cases occurred. It would be very interesting to see how many occured in the late 1980’s and early 1990’s before the widespread adoption of laparoscopic techniques. Of course, it’s important to make sure that nothing is left behind in any surgery. Counting instruments and sponges before and after a surgery is one inexpensive way to prevent this, but the study found that even in cases where the pre-surgical and post-surgical counts agreed, the stuff was left behind. The authors’ suggest that all emergency surgeries, open body-cavity surgeries, and all fat people have x-rays before leaving the operating room. They argue that the $100 cost of an abdominal film is far cheaper than the average $55,000 cost of settling a lawsuit. But, of course, it would cost far more than $100 per lawsuit avoided. It would cost $28.4 million X $100, or $2.8 billion to avoid $82.5 million in lawsuits. (at the high end). Limiting it to only the valid statistical estimate within the hospitals themselves would mean spending $1.9 million dollars in abdominal films to avoid one malpractice case settlement of $55,000. Of course, that cost would be passed on to the patient in higher surgery bills and eventually higher healthcare premiums. ADDENDUM: RangelMD has some thoughts on this, too. UPDATE: And here's a tale of medical equipment technician: When I was working on service of medical equipment, the machines were my "patients." I made it a point that the tool kits had "a place for everything and everything in it's place.." I learned this the hard way early on. One RT called me down to one machine and said, "When I started to set up for the first patient, there was a big 'Klunk' when I rotated the machine, so I brought the patient out of the room and called you. I checked things and quickly found that I'd left a flashlight in the machine when working very late the previous night. Carrying the offending instrument out of the room, I was asked by the waiting patient, (an old lady, with an accent reminding me of borcht,) "Is everyting ok now?" I explained that I'd left the flashlight in the machine the previous evening and she floored me with a statement I never forgot. "It's a good ting you're not a surgeon!" posted by Sydney on 1/17/2003 07:41:00 AM 0 comments 0 Comments: |
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