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A Human Factors Approach to Vaginal Retained Foreign Objects.

Tara N Cohen1, Falisha F Kanji1, Colby Souders2

  • 1Surgery, Cedars-Sinai Medical Center (Drs. Cohen, Dubinskaya, Sax and Ms. Kanji), West Hollywood and Los Angeles.

Journal of Minimally Invasive Gynecology
|January 5, 2022
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Summary

Vaginal retained foreign objects (RFOs) are rare but can occur. Human factors analysis identified skill-based errors and communication breakdowns as key contributors, suggesting interventions like teamwork training can improve patient safety.

Keywords:
Human factorsPatient safetyVaginal surgery

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Area of Science:

  • Healthcare quality and patient safety research.
  • Medical error analysis and prevention.
  • Surgical safety and risk management.

Background:

  • Vaginal retained foreign objects (RFOs) are infrequent but serious complications following gynecological procedures.
  • Understanding the root causes of RFOs is crucial for developing effective prevention strategies.

Purpose of the Study:

  • To apply a structured human factors analysis to identify conditions contributing to vaginal RFO events.
  • To classify contributing factors using the Human Factors Analysis and Classification System for Healthcare (HFACS-H).

Main Methods:

  • Retrospective analysis of 45 vaginal RFO events from January 1, 2000, to May 21, 2019.
  • Trained human factors researchers reviewed event narratives and classified contributing factors using HFACS-H.

Main Results:

  • The most common retained items were vaginal packing and sponges (53.33%), followed by broken instruments (20.20%).
  • Primary contributing factors included skill-based errors, communication challenges, coordination breakdowns, and issues with tools/technology design.
  • Laparoscopic hysterectomies and vaginal deliveries were the most common procedures associated with RFOs.

Conclusions:

  • Vaginal RFOs, though rare, necessitate attention due to potential patient harm.
  • Skill-based errors and communication breakdowns are the leading contributors to RFO events.
  • Human factors interventions, such as simulation, teamwork training, and workflow optimization, can mitigate RFO risks.