Atul Gawande: evaluation

Transcript context

…Great paper. We had done a case control study of this problem of surgeons leaving sponges inside people, and got it published in the New England Journal [of Medicine], partly because of our whole method of going about solving this problem, which was, we studied 60 people who had sponges left inside them, compared to 240 people at the same institution at the same time with the same operation who didn’t have sponges left inside them. That was an interesting problem to me because the rate of sponges being left inside people had been steady for 30 years. We had not made it go down at all. It was right around 1 in 1,000 to 1 in 3,000 or so operations. A sponge would be left inside, and it would be a disaster. You would have to go back. About two-thirds of the time, people had become infected. One of the 60 was a patient who died because a small sponge had been left in their brain. The usual way that we track these things is by counting everything at the beginning of the operation twice and everything at the end of an operation. What we found was that it wasn’t because people were skipping the steps along the way. The nurses were consistently counting everything at the beginning and counting everything at the end, so it wasn’t a broken system. It was a fallible system. It’s like counting whether you have 52 cards in the deck, and you have 51 or you have 53 at a predictable rate of getting the count wrong. And sure enough, about 1 in 1,500 to 1 in 3,000 times, they would just get it wrong and not know it. So we, in that case, identified that we would need to create a technological solution. In the end, we came up with a barcoding approach. It’s an interesting economic problem. At the time we were doing this, it was a $140-million sponge industry, for which there was half a billion dollars spent per year on lawsuits for sponges being left inside. From a pricing point of view, it worked out to about a penny a sponge. So you had to have a solution that could double the price to two cents or three cents, but you had to increase the costs a lot if you’re going to stick a microchip or a RFID system on there. So we just put barcoding on there, kept the cost pretty minimal, and it completely eliminated the problem because now you have a team scanning them in as they do the operation at the beginning of the operation, and then scanning all those sponges out. And the only fallibility is that people will ignore the machine. Those are the only times there have been sponges left after tens of millions of these kinds of cases. Do your awake patients ever come in with a checklist and at the end say, “Hey, have you got all your sponges?”…

Stored transcript either side of the excerpt. The highlighted words are the published quote; the surrounding text is unedited source, never generated.