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AORN Center of Excellence in Surgical Safety: Prevention of RSI

Sponsored by Stryker through the AORN Foundation

Stryker and AORN Foundation Logos

Facilities will receive recognition as an AORN Center of Excellence in Surgical Safety for implementation of this innovative surgical team-based program to prevent retained surgical items (RSI). The complimentary program uses engaging immersive technology and focuses on education, training, analysis, and quality improvement to prevent near misses and unintended consequences of RSI during operative and other invasive procedures.

  • Demonstrate team commitment to a culture of safety
  • Understand actions necessary to eliminate this surgical never event
  • Foster a collaborative work environment
  • Earn public recognition as a Center of Excellence in Surgical safety


RSI Center of Excellence

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What You’ll Learn:

  • Evidence-based education on human behaviors and environmental influences that lead to unintended RSI.
  • Procedures for accurately counting surgical items.
  • Strategies to increase compliance with counting processes before, during, and after procedures.
  • Guidelines for reconciling discrepancies, including the use of adjunct technologies to augment manual counts.

RSI remains in the top two preventable surgical sentinel events voluntarily reported to The Joint Commission each year. Studies have estimated as many as 1 in every 5,500 to 8,000 procedures involves an unintended retained surgical item (RSI), leading to adverse outcomes for patients. 1,2


Retained Surgical Items 
  • Interdisciplinary Approach to RSI Prevention
  • Incorporating Preventive Measures
  • Effective Reconciliation
  • Use of Adjunct Technology
  • Human Factors: Reducing Distractions and Communication Failures


Retained Surgical Items 

A Preventive Approach

Perioperative professionals who complete the comprehensive, multidisciplinary program will understand the root causes of RSI and learn multiple approaches to mitigate risks. Teams will engage in:

  • Scenario-based immersive technology
  • Short, online modules
  • Pre- and post-tests around knowledge of unintended RSI
  • Gap analysis tools for the OR
  • Process audits to confirm progress

Most Common Retained Items

The most common retained items in invasive procedures – in both hospitals and ASCs:

  • needles
  • sponges
  • wound packing
  • broken instrument parts

In 2014, the cost of one RSI incident averaged $70,767 nationally because of the extra care needed. Additionally, liability settlements related to RSIs are estimated at $150,000 per patient.3

Sign up today for more information & to be notified when the program is available.

Sponsorship by Stryker through the AORN Foundation

Stryker and AORN Foundation Logos