Surgeons and their staff juggle countless responsibilities while operating on a patient . The surgical team manages instruments, monitors patients, and communicates with each other to help ensure a safe and efficient procedure. And yet even during stat emergency procedures when time is critical, one of the most deceptively mundane surgical tasks remains one of the most critical: performing sponge, needle, and other surgical instrument counts to ensure that nothing has been inadvertently left behind inside the patient’s body, where it could have potentially harmful consequences.
For decades, solely relying on manual counting was the standard of care. Processes were developed in facilities to ensure all involved in a patient’s operation are aware of the step-by-step procedure, and they know how to verify that no instrument is left behind.
Yet even with the most diligent teams, human error is sometimes inevitable. A missed sponge can lead to devastating patient harm, wasted search time, costly litigation, and long-term reputational damage for hospitals. That’s why Tally, a medical service software designed to modernize and safeguard this process with speed, accuracy, and ease of use, is out to try and revolutionize the market.
Why the Count Matters Beyond Patient Safety
Surgical sponges are a critical supply for different operations across the board. This specialized sponge or pad is used during surgical procedures to absorb liquids from the surgical site, protect body tissues, and help to maintain a clear view of the body and organs where the patient is being operated on. Surgical sponges are essential for ensuring patient safety and the success of the surgery.
Leaving a surgical instrument inside a patient’s body is considered a “never event” in medicine. In other words, an event that should never happen1.
While these events are considered rare and there’s no national source that counts all qualifying retained surgical item incidents, the National Library of Medicine estimated around 1,500 cases per year in the US.2
Atul Gawande, professor of surgery at Brigham and Women’s Hospital states, “Rates of forgotten items after surgery have persisted for decades. To the extent, we have estimates that have gone back decades, they have been very consistent over time”. 3
The risks of retained surgical sponges go far beyond patient morbidity. When considering the financial implications, a single retained item can result in settlements exceeding $500,0004, with some cases climbing above $10 million.5
Beyond legal exposure, hospitals may face denied reimbursements, lost operating time, and staff strain when errors occur.
From an inventory perspective, Tally can help reduce waste by ensuring sponges are tracked, not misplaced or discarded unnecessarily. With real-time, timestamped data accessible on a secure mobile device, facilities gain a comprehensive record of usage. That information not only supports compliance and quality reviews but also strengthens insurance claims and risk management.
Simply put, cost avoidance with Tally may far exceed the price of the problem. By preventing even a fraction of errors, hospitals can protect both patients and budgets.
From Barcodes to RFID: The Evolution of Non-Manual Sponge Tracking
The idea behind Tally is rooted in early automatic identification efforts within the surgical field. In addition to manual counting, barcoded sponges (once considered an innovation) offered a step up in the overall process. The addition of barcodes, however, introduced workflow changes and delays that clinicians had a hard time adapting into their existing manual counting process.
Recognizing that technology needs to be both faster than barcodes and more intuitive than just manual counts, the Tally team turned to ultra-high frequency (UHF) RFID. Today, each sponge is tagged with a unique identifier, allowing clinicians to scan hundreds at once. The result: a real-time, accurate count that supplements, rather than disrupts, the existing workflow.
“Until it’s scanned out, it’s assumed to be in the patient,” Tally CEO Brian Stewart explained. “That assumption drives accountability and safety in ways solely conducting manual counts never can.”
An Adjunct, Not a Disruption
A core design principle behind Tally was ensuring adoption by fitting into existing workflows. The system is used by the same circulating nurses already responsible for sponge counts, meaning no additional staff are required.
Unlike some adjunct technologies that require counting items one at a time, Tally’s proprietary scanner can process up to 900 sponges per second.8 If one is missing, the system’s Find Mode allows the team to scan the room, like locating a misplaced phone, until the missing sponge is identified.
It’s important to note that Tally supplements, rather than replaces, manual counts. It aims to become another layer of assurance without slowing clinicians down.
Building Momentum in Healthcare
While competing products have existed since the early 2000s, many can require bulky hardware, extensive maintenance, or costly consumables. Tally distinguishes itself through:
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- Speed & Scale – Scans hundreds of items simultaneously in seconds.
- Simplicity – A single lightweight device replaces multi-component systems.
- Affordability – Lower cost of tags and system design make it the most accessible option to date.
- Data Integrity – Every scan is timestamped, HIPAA-compliant, and available for post-op reporting.
Stewart explains, “Clinicians and administrators alike can see value not just in the technology’s precision but in its ability to provide a clear, auditable trail of accountability. Something that proves invaluable if adverse events arise”.
Differentiating in the Market
After refining the technology during the pandemic, Tally officially launched their offerings at the AORN conference earlier this year (2025). Since then, it has entered Owens & Minor’s distribution network, with evaluations underway at multiple facilities. Proposals and in-service trainings are introducing surgical teams to the system’s benefits, while early adopters share strong feedback.
“Hospitals do not resist technology; they resist disruption,” former AORN board member and Tally beta tester states. “The speed and user-friendly nature of Tally allow it to seamlessly fit into existing workflows without slowing anyone down .”
Looking Ahead
The potential applications for Tally extend beyond the operating room. Labor and delivery suites, cath labs, and even outpatient clinics often lack formal count protocols, leaving gaps in patient safety. Expanding into these areas could dramatically reduce risk across the spectrum of surgical care.
As the healthcare system grapples with cost pressures, staffing shortages, and increasing patient volumes, solutions like Tally may offer some relief when it comes to risk mitigation through new technology implementation. The team behind Tally acknowledges the limits of human performance, embraces technology as a partner, and offers a scalable, cost-effective pathway to safer surgeries.
Conclusion
Retained surgical sponges remain one of the most preventable yet persistent risks in healthcare.3 Manual counts, while essential, are prone to error in environments where clinicians are stretched thin.8
Tally doesn’t aim to replace human diligence but to amplify it, providing speed, precision, and peace of mind when it matters most.
By combining advanced RFID technology with a clinician-friendly design, Tally offers hospitals a practical tool to reduce risk, control costs, and protect patients. In an industry where even a single error can carry devastating consequences, that’s innovation worth considering.
Citations
- Rettner, R. (2018, February 21). Here’s what happens when you leave surgical sponges in a person’s body for years. Live Science. https://www.livescience.com/61825-woman-had-two-sponges-inside-body.html
- Zejnullahu, V. A., Bicaj, B. X., Zejnullahu, V. A., & Hamza, A. R. (2017). Retained surgical foreign bodies after surgery. National Library of Medicine – National Center for Biotechnology Information. https://pmc.ncbi.nlm.nih.gov/articles/PMC5320916/
- Munson, E., & Darwiche, L. (2025, April 3). Surgeons continue to mistakenly leave objects in thousands of patients. Times Union. https://www.timesunion.com/projects/2025/hospitals-surgical-objects-patients/
- Munley Law Personal Injury Attorneys. (2025). Lawsuit settles for $650K after sponge left in patient. https://munley.com/florida-hospital-settles-suit-after-sponge-was-left-in-stomach/
- Lubin & Meyer PC. (2019, March 26). Post-surgical infection lawsuit: $10.7 million verdict. https://www.lubinandmeyer.com/cases/surgery-mistake-verdict.html
- STERIS Healthcare. (2023, February 13). Retained surgical items: Prevention and solutions. STERIS. https://www.steris.com/healthcare/knowledge-center/surgical-equipment/retained-surgical-items
- Stanton, C. (2024, April 1). Cracking the code to prevent retained surgical items. AORN.org. https://www.aorn.org/outpatient-surgery/article/cracking-the-code-to-prevent-retained-surgical-items
- Tally Surgical, Inc. (2025). Tally Surgical: The next generation retained surgical sponge prevention solution. https://www.tallysurgical.com