RF-based systems are passive radio frequency detection systems analogous to using a metal detector at the beach. After a procedure is finished and the final count has been performed, if either 1) there still remains an incorrect count or if 2) the procedure has been predetermined to have a high risk of retained sponges, staff must chose to open and use the disposable RF wand to scan the patient. The wand is waved over the patient in a strict twelve-step procedure. If a sponge is discovered, the attached console beeps and flashes.

Besides the significant interference issues raised in the JAMA study, there are many flaws in an RF-based approach:

1.    It does not count
   As that an RF-based system is only a "beep.beep"-style detection system, its approach simply does not directly address the root cause of retained sponges - false "correct" counts - since it can only try to locate a sponge and cannot help verify electronically (and more accurately) that the counts are correct in the first place. As that surgeons typically find a sponge known to have remained in the body without a RF device, the best approach to reducing retained sponges is to improve the accuracy of the count to let staff know that they need to go back into the patient and find a missing sponge.
2.    It forces hospitals/surgeons to profile their patients
   Studies prove that there is no profile of whom retained items can happen to. Manufacturers and distributors of RF based products recommend profiling patients by utilizing the disposable wands only in cases where the counts have been incorrect or in certain “high risk” procedures, with the side benefit of keeping the per procedure cost down. SurgiCount believes that any adjunct technology must be used on all patients and every procedure since retained sponges occur in all procedures, even breast biopsies. A complete deployment is in accordance with the Joint Commission mandate that “identified processes be implemented across the services” as well with good practices.
3.    It potentially puts staff into ethical dilemmas
The detecting wands are one-time disposables requiring new wands after each use. IF use on every case is not mandated, this potentially puts pressure on staff to not want to add the cost of opening and utilizing the wand to the procedure because the count was thought correct or if it is “felt” that no sponges remain in the patient.
4.    Lack of proof to claims of clinical and empirical safety and success
   1. RF-based companies do not substantiate the claims on their brochure and websites that their technology is “proven” by offering any documentation or study either of the accuracy and effectiveness of their products or of the base science behind the products
   2. Offhand claims of “proof” by way of deployment in other industries is not comparable.  A clothing retailer may be happy with 85% accuracy in return for the ability to reduce inventory-taking staff headcount by three people. That clothing store however does not have morbidity issues when a t-shirt goes missing because of the 15% error rate.
5.    Technological issues
   1. Radio frequency technologies have clear, undeniable and well documented problems being able to transmit through liquids and metals, let alone the different densities found within a human being. RF companies do not publicly provide information regarding the limitations of their technology. False negatives scans are possible.
   2. As the recent JAMA article discussed, radio frequency devices can very easily interfere with other vital pieces of equipment in the OR such as ventilators and pacemakers.
   3. The FDA and CDRH has reported tests of their own as interfering with equipment and pacemakers.
   4. RF frequencies from other products (car keys, door passes, pacemakers) can cause false positives reads
   5. Tags can fail/become inert and not be discoverable
6.    Cost
   The additional per procedure cost of sponges is between $40-$65
7.    User error remains
   User error completely remains with wanding patients in regards to the distance held  over a patient, speed of moving the wand.
8.    No documentation of sponges
   1. No electronic records exist
   2. No sponge information is saved for record keeping
   3. No possibility to examine reports electronically at  a later time