Work as Imagined Versus Work as Done: A Usability Evaluation of an RFO Sponge-counting System in Real Operating Room Conditions

OBJECTIVES: Retained foreign objects are surgical items accidentally left inside the patient after skin closure at the end of an operation. The surgical count is the primary method for preventing retained foreign objects, and surgical sponge detection devices are increasingly used to aid in prevention. The objective of this study was to investigate usability, functionality, and user responses to 1 such sponge accounting device. METHODS: Interactions with the sponge accounting device were directly observed during 17 surgical procedures (including laparoscopic, cesarean section, and general surgery). Data was collected quantitatively through a categorical time study and the System Usability Scale, in conjunction with qualitative ad hoc in situ interview data. RESULTS: Thirteen participants completed the System Usability Scale, and the average score of the device was M=58, indicating marginally acceptable usability. Other findings included concerns with the efficiency and reliability of the accounting device, especially with heavily soiled sponges, and variability in its use. CONCLUSIONS: This "in the wild" evaluation of the device revealed challenges with its intended use in a busy surgical environment. This work adds to the literature in that it highlights the importance of appreciating the challenge of integrating new technology into a busy health care environment, as well as the value of completing usability testing before device implementation.