Performance Modeling and Analysis of Surgery Patient Identification Using RFID

Introduction

Improvement in patient safety in medical care continues to be a very important issue in the medical care community. According to an Institute of Medicine (IOM) report, 44,000 to 98,000 people die each year as a result of preventable medical errors (Kohn, Corrigan, & Donaldson, 1999). The percentage of hospital inpatient admissions experiencing adverse events has been estimated at 3.7% in the U.S., 16.6% in Australia, and 10% in the UK (MF & JD, 2004). Various types of medical errors occur during the course of healthcare delivery, such as improper transfusions, wrong-site surgery, and mistaken patient identities. High error rates with serious consequences are most likely to occur in intensive care units, such as operating rooms and emergency departments (“What an unbelievable surgery!-Perform an operation with exchanged charts,” 2006). Many of these medical errors are due mainly to avoidable human errors that can be potentially eliminated by proper design and error-proofing of the associated workflow. Surgery generally involves the execution of many complex tasks and each task is composed of multiple steps. The most common human error in the medical process is unintentional omission of one or more steps, especially when there are a large number of steps (Reason, 2002).

Patient identification is one of the necessary processes performed prior to anesthesia and surgery. Errors in this process can lead to unrecoverable medical accidents and there are numerous such accidents reported (“What an unbelievable surgery!-Perform an operation with exchanged charts,” 2006). One instance of such an error involved intake nurses and surgery doctors: two patients––one with thyroid cancer and one with stomach cancer––had their identities exchanged in the surgery. As a result, the thyroid of the patient with stomach cancer was removed and the stomach of the patient with thyroid cancer was removed. There are other instances where medical doctors have reported performing invasive procedures on the wrong patients (Mark R. Chassin & Elise C. Becher, 2002).

The IOM report revealed that the majority of medical errors are not caused by individual recklessness or the actions of a particular group (Kohn, et al., 1999). More commonly, faulty systems, processes, and conditions lead people to make mistakes or fail to prevent them. Therefore there is a need to design and error-proof workflow systems that render human error essentially impossible or at least extremely difficult (Etchells, O’Neill, & Bernstein, 2003). Barcode system such as the Global Service Relation Number (GSRN) from GS1, which is used to identify patients and the services provided to them, may be helpful in addressing some of these needs (http://www.gs1.org/docs/patient_safety). However, use of such a barcode system may impose awkward constraints on the surgery team because a bar code must be within the line of sight of the scanner. Ideally, patient identification technology should be simple and reliable so that the overall activities and associated workflow of the surgical team is smooth and efficient. In this context, RFID technology offers an attractive solution because it does not need a line of sight and its reading range is greater than that involved with a barcode system. RFID technology is one potential solution in resolving occurrences of patient misidentification (Fisher, 2006; MF & JD, 2004).