1,300 Days and Counting: A Risk Model Approach to Preventing Retained Foreign Objects (RFOs)

Area of Science:

• Surgical Safety
• Healthcare Improvement
• Patient Outcomes

Background:

• Retained foreign objects (RFOs) are severe surgical complications leading to increased morbidity, mortality, and healthcare costs.
• Memorial Sloan Kettering Cancer Center (MSKCC) initiated a task force to address and reduce RFO incidents.

Purpose of the Study:

• To implement and evaluate a multidisciplinary improvement initiative aimed at preventing retained foreign objects in surgical procedures.
• To develop and apply a probabilistic risk model for RFO prevention.

Main Methods:

• Conducted a needs assessment using focus groups, past RFO reviews, and operating room observations.
• Reclassified items at risk, developed new tracking sheets, and created a probabilistic RFO risk model.
• Launched training programs to enhance staff awareness and promote a culture of proactive RFO prevention.

Main Results:

• Achieved zero RFO incidents since the initiative's implementation on March 24, 2014, with the last incident in August 2013.
• Reduced RFO incident frequency from 1.69 per year to an estimated 1 in 22 years.
• Sustained behavioral changes and improved organizational culture through ongoing training.

Conclusions:

• A multidisciplinary approach, including a robust RFO risk model, proved highly effective in preventing retained foreign objects at MSKCC.
• Leadership support, stakeholder engagement, comprehensive education, and frontline staff cooperation are critical for successful RFO prevention.