UCSF Medical Center is part of the University of California, San Francisco, one of the 10 campuses of the University of California. The 560-bed facility has the only nationally designated Comprehensive Cancer Center and the only Center of Excellence in Women’s Health in Northern California. In April of 2007, USCF Perioperative Services launched the Retained Item Initiative as part of an ongoing effort to reduce the number of foreign bodies left in patients; since implementing a cutting-edge bar coded sponge management system, no incidents have been reported. Recently, HCI Associate Editor Kate Huvane Gamble had an opportunity to speak with CMIO Michael Blum, M.D., about this initiative, as well as future plans for UCSF.
KG: UCSF Medical Center is one of only a handful of healthcare organizations in the country that has implemented bar coded sponge management in order to prevent foreign bodies being left in patients. Is this issue a big priority at UCSF?
MB: We’ve been working on the concept for years to try to reduce anything left behind. I think it’s unacceptable to unintentionally leave anything behind. That’s been the philosophy over the last two years. We’ve put more focus and attention on it, and we’ve really started looking at technologies we could bring to bear. Obviously there’s more attention focused on it now as it’s a ‘never event’ for CMS. So it’s been one just of the elements of our overall patient safety and reduction campaigns for several years.
In addition to the bar coding aspect for sponges, there’s also the RFID approach that’s evolving that we looked as well but it wasn’t quite as far along, and we needed to implement some technology in this space. So we ended up going with the bar coding approach as a first pass at it.
KG: What method was being utilized before the sponge tracking system was put in? Was it a manual process involving white boards?
MB: Yes, that’s what we were doing.
KG: So you decided to see if bar-coding could help improve accuracy?
MB: Our general philosophy is that you need to use the technology where it replaces activities that human beings can’t do particularly well, as counting is one of the things that machines can do much better than people do. Computers can count much better and much more reliably; tracking things better and more reliably. So taking tasks that need to be automated and repeated and don’t have cognitive function as part of them, but just have counting or automation — we try to move as much as possible to technology in those spaces to really minimize the risk. You can’t expect people to do things at 100 percent, no matter how many times they do it. No matter how well-trained they are, no matter how much they focus on it, human beings just don’t operate that way. So in those spaces, we either back them up with technology or we replace the task with technology.
This was a pretty obvious opportunity to deploy that as we can. Now having said that, you still have to make sure that the workflow you develop around it makes it so that the technology is appropriately utilized. For instance, the benefit of this technology is that it counts really well and it recognizes things really well, but it doesn’t do a lot of other pieces, and so people can find workarounds, which can foil the technology if you’re not careful with how you implement it. If you implement it so that it takes a lot of extra time or it’s a barrier to clinical care, people will figure out ways to defeat it. So just as important as choosing the technology, the choosing the vendor and choosing which piece you like best is making sure that it meets the workflow needs so that fits and integrates well. Either you redo the workflow, or it fits into the existing workflow, one or the other.
KG: Who was the driver in this project, and what was your role?
MB: This was driven by perioperative. The perioperative space is somewhat self-contained; there’s a separate medical director. In this particular patient safety example, they really ran and were responsible for most of the clinical buy-in and cultural change. But on a general level in a hospital or medical center, that would be one of my responsibilities; in addition to evaluating the technology and evaluating the appropriateness of it, it would be my responsibility to evaluate it in the context of the clinical environment and the workflow. And then once we decided we thought it would work and we thought we could benefit from it, and once we started gearing up and doing the project management and developed a project around it and as we started doing the implementation, my responsibility would be to bring it to the clinicians and explain to them the rationale for doing it, what’s going to change, what the benefits are going to be, how it’s going to impact their lives, what’s in it for them, what’s in it for the patients, all of that, and getting people on board to make the changes that are going to necessarily.
Usually this is squarely on my plate, but in this case we had other people who carried it.