赛车全天人工计划稳定版

好英语网好英语网

好英语网 - 365edm.com
好英语网一个提供英语阅读,双语阅读,双语新闻的英语学习网站。

一块代价250万美元的医用纱布

When Surgeons Leave Objects Behind
一块代价250万美元的医用纱布

On an overnight shift in 2005, Sophia Savage, a nurse in Kentucky, felt a crushing pain in her abdomen and started vomiting.

2005年,美国肯塔基州正在值夜班的护士索菲亚·萨瓦奇(Sophia Savage)突然感到腹部传来一阵撕裂般的疼痛,然后开始呕吐。

The next day she underwent a CT scan, which led to a startling diagnosis: A surgical sponge was lodged in her abdomen, left behind, it turned out, by a surgeon who had performed her hysterectomy four years earlier.

第二天她做了一次CT检查,诊断结果让人大吃一惊:看起来四年前做子宫切除术时,一块放在她腹腔内的医用纱布被主刀大夫遗落在了她的体内。
 

Ms. Savage's doctor ordered immediate surgery to remove the sponge.

萨瓦奇的医生于是要求进行紧急手术,将纱布取出。

"What they found was horrific," Ms. Savage said. "It had adhered to the bladder and the stomach area, and to the walls of my abdominal cavity."

“他们发现的结果太可怕了,”萨瓦奇说,“纱布粘在了膀胱、胃部和腹腔壁上。”

The festering sponge had spread an infection, requiring the removal of a large segment of Ms. Savage's intestine. She sued the hospital where the hysterectomy had taken place, and in 2009 she won $2.5 million in damages. But the award has been appealed, and her life has been in tatters. Suffering from severe bowel issues and unable to work, Ms. Savage, 59, has been racked by anxiety and depression. Most days, she said, she cannot bring herself to leave home.

破溃的纱布引起感染,导致萨瓦奇的一大截肠道被切除。她起诉了给她做子宫切除术的那家医院,在2009年获得250万美元赔偿金。但医院已经就此提出上诉,她的生活则已支离破碎。她出现了严重的肠道问题,无法工作,饱受焦虑和抑郁症的困扰。现年59岁的萨瓦奇说,大多数时间里,她都无法迈出家门。

"I never dreamed something like this would happen to me," she said.

她说,“我做梦也没有想到这样的事情会发生在我身上。”

Every year, an estimated 4,000 cases of "retained surgical items," as they are known in the medical world, are reported in the United States. These are items left in the patient's body after surgery, and the vast majority are gauzelike sponges used to soak up blood. During a long operation, doctors may stuff dozens of them inside a patient to control bleeding.

据报道,美国每年估计有4000起“手术遗留物”(医学界的称呼)事故发生。“手术遗留物”指手术后遗落在患者体内的物品,而这些物品中绝大多数是用来吸血的纱布。在一台时间较长的手术中,医生可能会在患者体内塞上数十块纱布来止血。

Though no two cases are the same, the core of the problem, experts say, is that surgical teams rely on an old-fashioned method to avoid leaving sponges in patients. In most operating rooms, a nurse keeps a manual count of the sponges a surgeon uses in a procedure. But in that busy and sometimes chaotic environment, miscounts occur, and every so often a sponge ends up on the wrong side of the stitches.

虽然没有完全相同的两个案例,但专家说问题的核心在于外科手术团队仍在依赖老办法来避免将纱布遗留在患者体内。在大多数手术室里,一名护士负责人工清点外科大夫在手术过程中使用的纱布。但在那种忙碌、有时甚至混乱的环境中,护士时常会数错了纱布数量,所以纱布经常被留在手术缝合口内。

In recent years, new technology and sponge-counting methods have made it easier to remedy the problem. But many hospitals have resisted, despite the fact that groups like the Association of Operating Room Nurses and the American College of Surgeons have called on hospitals to update their practices.

最近几年,新技术和新的纱布清点办法可以更容易地解决这一问题。但是,尽管手术室护士协会(Association of Operating Room Nurses)和美国外科医师学院(American College of Surgeons)这样的组织号召医院与时俱进,很多医院仍然在抗拒。

As a result, patients are left at risk, said Dr. Verna C. Gibbs, a professor of surgery at the University of California, San Francisco.

加州大学旧金山分校(University of California, San Francisco)外科教授韦尔娜·C.吉布斯(Verna C. Gibbs)博士说,医院如果不能与时俱进,其结果就是让患者面临风险。

"In most instances, the patient is completely helpless," said Dr. Gibbs, who is also the director of NoThing Left Behind, a national surgical patient safety project. "We've anesthetized them, we take away their ability to think, to breathe, and we cut them open and operate on them. There's no patient advocate standing over them saying, 'Don't forget that sponge in them.' I consider it a great affront that we still manage to leave our tools inside of people."

吉布斯说,“在大多数情况下,患者是孤立无援的。”她也是一个全美手术患者安全项目——“什么也别遗落”(Nothing Left Behind)的主管。“我们麻醉了他们,剥夺了他们思考、呼吸的能力,将他们的身体切开,在他们身上进行手术。手术室里没有维权人士站在患者旁边说,‘别忘了他们体内的纱布。’我觉得现在还在把器械遗落在患者体内,简直是一种奇耻大辱。”

All sorts of tools are mistakenly left in patients: clamps, scalpels, even scissors on occasion. But sponges account for about two-thirds of all retained items.

误留在患者体内的医疗器械五花八门:手术钳、手术刀,有时候甚至是手术剪。但在所有遗留物里,纱布占到三分之二。

When balled up, soaked in blood and tucked inside a patient, a 4-by-4-inch cotton sponge is easy to miss, especially inside large cavities. Abdominal operations are most frequently associated with retained sponges, and surgeons are more likely to leave items in overweight patients.

一块4x4英寸的棉质纱布,它揉成一团、浸透鲜血、塞在患者体内,很容易被忽略,在相对较大的腹腔内尤其如此。腹部手术最常发生纱布遗落事故,而最有可能遭遇类似事故的往往是身体过重的病人。

Hospitals traditionally require that members of a surgical team, usually a nurse, count - and then recount, multiple times - every sponge used in a procedure. But studies show that in four out of five cases in which sponges are left behind, the operating room team has declared all sponges accounted for.

传统上,医院要求外科手术团队清点手术过程中的每一块纱布,随后再进行多次清点,这项工作通常情况下由一名护士负责。但是,研究表明,在80%纱布被遗落的案例中,手术室医务人员都声称所有的纱布都是清点过的。

Now hospitals have a more technological approach at their disposal. They can track sponges through the use of radio-frequency tags. In a study published in the October issue of The Journal of the American College of Surgeons, researchers at the University of North Carolina at Chapel Hill looked at 2,285 cases in which sponges were tracked using a system called RF Assure Detection. Every sponge contained a tiny radio-frequency tag, about the size of a grain of rice. At the end of an operation, a detector alerts the surgical team if any sponges remain inside the patient. In the U.N.C. study, the system helped recover 23 forgotten sponges from almost 3,000 patients over 11 months.

现在医院有了一种更科学的办法可供使用。他们可以利用无线射频标签来追踪纱布。在一篇发表在10月份的《美国外科学院学报》(The Journal of the American College of Surgeons)的文章中,北卡罗来纳大学教堂山分校(University of North Carolina at Chapel Hill)的研究人员分析了2285个利用无线射频探测(RF Assure Detection)系统来追踪纱布的病例。每块纱布都植入一个米粒大小的微型无线射频标签。每次手术结束以后,如果有纱布留在了患者体内,探测器就会提醒手术人员。在北卡罗来纳大学所做的这项研究中,在11个月里,该系统从将近3000名患者体内,帮助医生发现了23块险些就要遗留的纱布。

Created by a thoracic surgeon at Weill Cornell Medical Center in New York, the RF Assure system adds about $10 to the cost of a procedure, roughly the cost of a single suture used in surgery.

无线射频探测系统是由位于纽约威尔康乃尔医学中心(Weill Cornell Medical Center)的一位胸外科医生开发的,使用它会让每次手术增加10美元左右的费用,大致相当于手术中单次缝合的成本。

"It's a small price to pay to enhance patient safety," said Dr. Leo R. Brancazio, the medical director of labor and delivery at Duke University Hospital in North Carolina, which adopted the RF Assure system about 18 months ago, after a sponge was left inside a patient during a Caesarean delivery. "It's one extra step that takes 12 seconds at the end of a procedure."

北卡罗来纳州杜克大学医院(Duke University Hospital) 在一年半前采用了无线射频探测系统,在那之前他们曾把纱布遗落在了一位剖腹产患者的体内,该院妇产科主任李奥·R·布兰卡齐欧(Leo R. Brancazio)医生说:“只需要花很少费用,就能保障患者的安全。在手术结束时,这个附加的步骤只需要区区12秒钟。”

Another tracking system relies on bar code technology. Every sponge receives a bar code, which is scanned before use and scanned again as it is retrieved.

除此之外还有一种追踪系统,它使用的是条形码技术。每块纱布都接收一个条形码,在使用前扫描一次,回收时再扫描一次。

Electronic tracking can be a safety net when manual counting fails. Yet nationwide, fewer than 1 percent of hospitals employ it, said Dr. Berto Lopez, an obstetrician-gynecologist and the chief of the safety committee at West Palm Hospital in West Palm Beach, Fla.

位于佛罗里达州西棕榈滩的西棕榈医院(West Palm Hospital)的妇产科医生、医院安全委员会主席贝尔托·洛佩斯(Berto Lopez)博士说,人工清点失误时,电子追踪系统可以充当一道安全网。然而在美国范围内,只有不到1%的医院采取了这项措施。

Dr. Lopez became an advocate for electronic tracking after he was sued in 2009 for leaving a sponge inside a patient - an error that occurred, he said, after two nurses assured him that all sponges had been accounted for. He now refuses to operate in any hospital that does not use electronic tracking.

2009年,洛佩斯因为把一块纱布遗留在患者体内而被起诉,此后他就开始倡导使用电子追踪系统——他说,当时有两个护士跟他确认说,所有纱布都已经点清了,结果才出了这个纰漏。现在他拒绝在任何没有采用电子追踪系统的医院进行手术。

"When something bad happens to you, you get religion," he said. "I've been rampaging ever since this happened. You study the subject, and you realize that this happens to a lot of people."

“当你碰到了些糟糕的事情后,你就开始有了信仰,”他说:“这件事以后,我曾气得发疯。但研究了这个问题以后,我才意识到原来很多人都曾遇到过这种事儿。”

Dr. Lopez, who said he had no financial interest in tracking systems, said that even though radio-frequency tracking is relatively cheap, many hospitals do not want the added expense.

洛佩斯声明他在电子追踪系统上没有任何商业利益,他说尽管无线射频追踪系统相对便宜,很多医院还是不想增加费用。

"In my heart, I think it comes down to hospitals not wanting to spend the 10 bucks," he said.

他说,“在我看来,我觉得归根结底是这些医院不愿意花费10美元。”

But Dr. Gibbs, of NoThing Left Behind, said technology should be only an adjunct to manual counting. Some hospitals now use inexpensive "counter bags" that resemble the shoe storage bags that hang from closet doors. Each sponge has its own compartment. If a compartment is empty at the end of an operation, a nurse can see that a sponge is missing. Then, Dr. Gibbs said, an electronic tracking system can help find the missing sponge.

但是“什么也别遗落”项目的吉布斯博士说,技术应该只是人工清点的辅助手段。一些医院现在使用廉价的“计数袋”,类似于挂在衣柜里面放鞋的袋子。每块纱布都有对应的格子。如果手术结尾时,其中的一个格子是空的,护士就知道有一块纱布丢失了。吉布斯说,接下来电子追踪系统就能够帮助找到那块失踪的纱布。

At the same time, she added, sponge counts should not be the sole responsibility of nurses: Everyone in an operating room must share accountability. Surgeons can tell nurses where sponges are being placed, for example, and conduct thorough wound exams to look for sponges before stitching up a patient.

她补充说,同时,清点纱布也不应该只是护士的职责:手术室里的每一个人都应该负起责任。比如,外科医生可以告诉护士纱布都放在什么部位了,在将患者缝合之前,彻底检查手术切口来寻找纱布等物品。

"Technology is but an aid," Dr. Gibbs said. "The way that safety problems are corrected and fixed is by changing the culture of the O.R."

“科技只是一种辅助手段,”吉布斯说:“想要纠正和改善安全问题,需要改变手术室的文化。”
上一篇: 尽情享受咖啡吧
下一篇: 返回列表

相关推荐

隐藏边栏