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Home E-Weekly October 8, 2013

A "Black Box" in Every OR?

Published: October 7, 2013

When airliners crash, investigators retrieve the flight data recorder to determine what went wrong. A Canadian surgeon has developed the same "black box" technology for ORs to find out why adverse events happen and what can be done in the future to improve patient safety and enhance surgical outcomes.

"It's amazing how the aviation industry approaches error analysis and how they're able to identify the root cause and chain of events that led to a disaster," says Teodor Grantcharov, MD, PhD, an associate professor in the department of surgery at the University of Toronto and a general surgeon at Toronto's St. Michael's Hospital. "It's quite unbelievable that we haven't yet done this in surgery."

His black box platform captures video from the surgeon's imaging equipment and from a camera mounted in the operating room. It also captures audio recordings of surgical team interactions, tracks physiological data from the anesthesia monitor, and records the room's decibel levels and air temperature.

"The exciting part is the software," says Dr. Grantcharov. "It syncs all the inputs, which timestamps every event during surgery. We can look at each event from many different angles."

When reviewing a specific moment during a case, for example, he can check the patient's vital signs, listen to what the surgical team was discussing, see what they were doing and watch the surgeon's technique. The goal is to determine the factors that led to an error, and come up with ways to limit those factors from harming again.

Dr. Grantcharov is in the midst of a year-long data capture, so he records cases, analyzes them within 24 hours and collects patient outcome information at 30 days post-op. He's aiming to release his findings sometime next year. For now, he offers a sneak peek: "The number of errors and adverse events in the OR that require corrective measures are more than we thought," he says.

In the future, he believes the black box will be used to analyze adverse events or assess new procedures, technology and techniques. But will surgeons and surgical teams resist technology that watches and records their every move, especially in a litigious society? Dr. Grantcharov appreciates those concerns, but believes putting black boxes in ORs serves a greater purpose.

"If it's done well and used constructively, the potential to enhance patient safety is significant," he says. "This is not about the surgeon or the surgical team. Everything that's going on in the OR is about the patient."

Daniel Cook

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