title: Miscount incidents: a novel approach to exploring risk factors for unintentionally retained surgical items.
abstract: BACKGROUND
  An estimated 1,500 operations result in retained surgical items (RSIs) each year in the United States, resulting in substantial morbidity. The rarity of these events makes studying them difficult, but miscount incidents may provide a window into understanding risk factors for RSIs.
  
  
  METHODS
  A cohort study of all consecutive operative cases during a 12-month period was conducted at a large academic medical center to identify risk factors for surgical miscounts. A multidisciplinary electronic miscount reconciliation checklist (necessitating both surgeon and nurse input) was introduced into the internally developed electronic Perioperative Information Management System to build a predictive model for RSI cases.
  
  
  RESULTS
  Among 23,955 operations, 84 resulted in miscount incidents (0.35% [95% confidence interval: 0.28% to 0.43%]). Increased case duration was strongly associated with increased risk of a miscount in unadjusted analyses (p < .0001). In the nested case-control analysis, both the case duration and the number of providers present were independently associated with a more than doubling of the odds of a miscount, even after adjustment for one another, the elective/urgent/emergent status of a case, and personnel changes occurring during the case.
  
  
  CONCLUSIONS
  The finding that both the length of the case and the number of providers involved in the case were independent risk factors for miscount incidents may offer insight into risk-targeted strategies to prevent RSIs, such as postoperative imaging, bar-coded surgical items, and radiofrequency technology. Miscounts trigger use of the Incorrect Count Safety Checklist, which can be used to determine whether a count completed at the procedure's conclusion is consistent across disciplines (circulating nurses, scrub persons, surgeons).
authors.affiliation: Weill Cornell Medical College, New York City, NY, USA. tij2004@med.cornell.edu
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Judson
authors.forename: Michael D
authors.initials: MD
authors.lastname: Howell
authors.forename: Charlotte
authors.initials: C
authors.lastname: Guglielmi
authors.forename: Elena
authors.initials: E
authors.lastname: Canacari
authors.forename: Kenneth
authors.initials: K
authors.lastname: Sands
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000367:Age Factors; D015331:Cohort Studies; D005547:Foreign Bodies / Q000145:classification* / Q000453:epidemiology*; D006801:Humans; D010564:Personnel, Hospital / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States