Design Requirements for Future Technology to Enhance Surgical Instrument Counting

Design Requirements for Future Technology to Enhance Surgical Instrument Counting: An Observational Study at the Reinier de Graaf Gasthuis

de Rouw, Lieke (TU Delft Mechanical, Maritime and Materials Engineering)

Delft University of Technology

Biomedical Engineering

2023-08-22

INTRODUCTION Surgical counting of instruments forms a crucial part of safety procedures in the operating room (OR). This process has remained primitive without technological support. The manual count process is time-consuming and places heavy cognitive demands on nurses. Current technological approaches fail to detect the exact and detailed usage of surgical instruments under real-life OR conditions. This research aims to enhance surgical instrument counting in the hospital by identifying challenges in the pre-operative, intra-operative, and postoperative phases and formulating design requirements for future technology.
METHODS An observational study was conducted in a large teaching hospital in Delft. The process of surgical instrument counting was assessed in the pre-operative, intra-operative, and postoperative phases of 50 surgeries. Nurses were surveyed to assess the method used, the experienced workload, and the willingness to adopt technology for surgical counting. The sterilization department provided data on the number of additional surgical instruments found on surgical trays after surgery and data on the different types of surgical trays delivered to the hospital.
RESULTS In all surgeries, surgical instrument counting was not performed according to the hospital’s protocol due to limited time and resources. Nurses used a technique to memorize the surgical instrument count by placing the surgical instruments in even numbers on the surgical instrument table. Surgical instruments were retrieved from their original surgical tray and placed on a surgical instrument table in case of frequent use or retrieved from their surgical tray and promptly handed to the surgeon in case of infrequent use. The return of surgical instruments to the surgical trays occurred intermittently, mostly when the surgical instrument was not deemed necessary anymore for the remaining surgery. After sterilization, occasionally incomplete surgical trays arrived at the hospital (10,0%), necessitating additional surgical trays to be added to the sterile field. During a 16-week timeframe, 801 additional surgical instruments were found on surgical trays indicating they were not returned to their original surgical tray. All nurses were willing to adopt technology for surgical counting, specifically in the pre-and postoperative phases.
CONCLUSION This study highlighted the challenge of balancing protocol, ensuring patient safety, and working efficiently. A control measure for the initial and final surgical instrument count is necessary for every surgery, as the current technique is insufficient. The design requirements for future technology are monitoring counts in the preparation room (PR) and OR, adjusting to accommodate additional surgical trays, having a focal area on the surgical tray, and identifying incomplete surgical trays. Future technology could enhance surgical instrument counting at the Reinier de Graaf Gasthuis by ensuring the presence and return of used surgical instruments to their original surgical tray.

Observational study
surgical instrument counting
operating room
patient safety
efficiency
technological design requirements

http://resolver.tudelft.nl/uuid:e93a7059-e84a-4a1b-bd56-91b62ee205db

Student theses

master thesis

© 2023 Lieke de Rouw