Operating rooms are managing more complex cases, more vendor trays and growing regulatory demands amid persistent workforce pressures. In that environment, relying on careful clinicians and manual processes alone leaves preventable gaps in surgical safety.
During a featured session sponsored by Stryker at Becker’s Healthcare Perioperative Summit on Sept. 15, Wayne McFatter, RN, MSN, systemwide executive director of surgical services at FirstHealth of the Carolinas in Pinehurst, N.C., and Crystal Fairclough, principal clinical consultant supporting Stryker, discussed how adjunct counting technology, real-time blood-loss measurement and better data can help perioperative leaders reduce risk.
Below are four takeaways.
1. OR complexity is outrunning manual safeguards
Mr. McFatter’s operating rooms perform 60 to 70 cases daily, about one-third of which are spine and total joint procedures. A single spine case can require 10 to 20 vendor trays, contributing to the 200 to 300 vendor trays moving through sterile processing each day.
At the same time, documentation remains fragmented, staffing remains difficult and regulatory requirements continue to grow. These pressures create more opportunities for manual steps to break down.
The challenge also extends to blood-loss measurement. Ms. Fairclough said visual estimates frequently underestimate blood loss, while manual documentation introduces additional opportunities for error.
The speakers argued that standardized systems capable of detecting, verifying, alerting and documenting can reduce reliance on individual clinicians performing every step correctly under pressure.
2. Leadership owns the process
FirstHealth of the Carolinas recorded three retained-sponge events in two years. All three sponges were discovered before the patients left the operating room, but because the incisions had already been closed, they qualified as retained-item events under CMS and Joint Commission definitions.
Mr. McFatter said each event involved human factors, including outside noise, loud music or a rushed count and no adjunct counting technology was in place. To him, that makes retained items a systems issue rather than evidence of an individual clinician’s incompetence.
“Preventing surgical harm is not just a clinical responsibility; it’s a leadership responsibility,” he said.
The effects extend beyond the operating room. Adverse events can increase length of stay, create legal and financial exposure, affect staff morale and turnover, and damage an organization’s reputation.
3. Real-time data
Perioperative leaders have historically relied on lagging measures that reveal problems after the opportunity to respond has passed. Mr. McFatter worked with his team to build a live huddle board that refreshes measures such as first-case on-time starts and same-day cancellations every few minutes, allowing teams to identify and address problems during the day.
Ms. Fairclough described the same principle in blood-loss management. Without real-time measurement, she said, teams may not quantify blood loss until well into a procedure or even near its conclusion. Technology that measures blood loss as sponges leave the field allows clinicians to recognize trends earlier and intervene before a patient reaches a critical threshold.
The value comes not simply from automating documentation, but from turning information into action.
“Without that learning piece, all you really have is automation,” Ms. Fairclough said. “You don’t really have improvement.”
4. The ROI of safety
Proving the return on adjunct technology has been one of Mr. McFatter’s biggest challenges. His argument combines efficiency with risk reduction.
When a sponge is missing, teams spend an average of about 20 minutes searching for it, he said. If an X-ray is required, the process can take about 26 minutes. X-rays detect retained items only about 68% of the time, according to Mr. McFatter, although larger objects such as sponges may be easier to identify than needles.
When his organization was performing at least 100 count-related X-rays annually, every ROI analysis he conducted showed a return from adjunct counting technology. The savings came from reducing imaging, avoiding lost OR time and lowering the risk of retained items. The technology also reinforces accountability by documenting whether teams followed the required count process.
“Count performance is an enterprise signal, not a nursing metric,” Mr.McFatter said.
He framed the business case for four executive audiences: reliable care for the CEO, avoidable costs and additional capacity for the CFO, throughput and standardized work for the CNO and COO and lower clinical risk for the CMO and quality leadership.
The goal is not simply to collect more information, he said, but to make care more reliable by ensuring every count is visible, every variance is actionable and zero harm is measurable.
