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Retained Foreign Object Signals a Dangerous Atmosphere in the Operating Room
Daniele Rigamonti1, Karen H Rigamonti2, Alessandra S Rigamonti3
1Neurosurgery,, Johns Hopkins Medicine, Pikesville, USA.
Cureus
|April 9, 2025
Summary
Retained foreign objects (RFOs) are a significant patient safety risk, often signaling an unsafe operating room culture. Addressing RFOs requires vigilance, standardized counting policies, and strong leadership commitment to safety.
Area of Science:
- Patient Safety
- Surgical Risk Management
- Healthcare Quality Improvement
Background:
- Retained foreign objects (RFOs), also known as unintentionally retained foreign objects (URFOs) or retained surgical items (RSIs), are a critical patient safety concern following invasive procedures.
- RFOs are the second most reported sentinel event (SE) after falls, highlighting their prevalence and impact.
- Factors contributing to RFOs include intraoperative blood loss, prolonged procedures, multiple surgical teams, and inadequate counting protocols.
Purpose of the Study:
- To analyze the contributing factors to retained foreign objects (RFOs) in surgical procedures.
- To emphasize the role of operating room (OR) culture in the occurrence of RFOs.
- To propose strategies for the elimination of RFOs and improvement of patient safety.
Main Methods:
- Review of factors contributing to retained foreign objects (RFOs).
- Analysis of technological solutions like bar-coded and RFID-tagged sponges.
- Assessment of the impact of operating room (OR) culture and policy on RFO incidence.
Main Results:
- Several factors increase RFO risk, including operative complexity, blood loss, and team dynamics.
- Technological advancements have shown potential but face limited adoption.
- A significant percentage of falsely correct counts indicates a critical role of unsafe OR culture.
Conclusions:
- RFOs serve as indicators of underlying issues within the OR environment and culture.
- A multipronged strategy involving vigilance, standardized policies, and staff accountability is essential for RFO elimination.
- Strong leadership commitment, resource allocation, and role modeling of safety values are crucial for fostering a safer surgical environment.
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