In the event of a discrepancy in instrument counts, which action is inappropriate?

• A. Pause surgery, resolve the discrepancy
• B. Verify counts
• C. Notify the surgeon
• D. Proceed with surgery before counts are resolved

Answer: (D)

Accurate counts are a patient safety safeguard in the operating room. When a discrepancy appears, treat it as a potential retained item and respond with a safety-driven process: pause the procedure, verify and re-count all instruments and materials, recheck the surgical field, instrument trays, and sponges, and determine what item is missing or mismatched. Notify the surgeon so the team can decide the next steps together. Only after the counts are thoroughly resolved and confirmed should the operation continue.

Proceeding with surgery before counts are resolved is inappropriate because it creates a real risk of leaving a foreign object inside the patient, which can lead to infection, obstruction, pain, or the need for additional surgery. This is why pausing, recounting, and informing the surgeon are essential, while moving forward without resolved counts is not acceptable.