Archive Hot Technology 2019

Real-time OR Monitoring Leads to Better, Safer Surgery

QA with Teodor Grantcharov, MD, PhD, FACS, creator of surgery's 'black box' and believer that data doesn't lie.

Teodor Grantcharov, MD, PhD, FACS

What is the "black box" and what is it designed to do?

It's a shoebox-size device that captures video and audio recordings of everything that happens in the OR, so we know what steps were completed and how well the team communicated. It also electronically documents physiological information from patient monitors and the physical environment of the room, including ambient temperature, decibel levels and how many times the door is opened. It's designed to identify near misses, understand the risks involved and proactively mitigate those risks.

Why is capturing real-time data so important?

The information captured by the black box is irrefutable evidence of what really goes on in the OR, so you can target specific solutions. We've shown that coaching surgical teams with black box data reduces the rate of surgical errors by 50%. The healthcare industry continues to invest billions of dollars in enhancing the safety of devices used during surgery, but we haven't seen improvements in safety outcomes. Without accurate data, you're trying to solve complex problems blindly.

This isn't just about targeting errors and near-misses, right? Exactly. We use the data to study successes in great detail, so we can identify and reinforce positive behaviors. We're using the information to coach surgical teams on ways to improve their performances, similar in many respects to how sports teams study videos and stats to enhance how they play.

How can the technology improve teamwork in the OR?

It's easier to have constructive conversations with members of the surgical team about things that might go wrong and also about how they can work closely to have a positive work experience. It also helps to flatten the hierarchy of the OR. When we first introduced the black box at our hospital, some nurses thought it'd be used to play the blame and shame game. But they quickly realized it provides information that leads to open discussions about improving the performance of their teams. It's led to a much healthier work environment.

Is there a place for the black box in every OR?

I think so. The most exciting aspect of the technology is that it's a platform for change. Acceptance of the black box will require a significant culture shift among surgical professionals. It's not going to happen overnight, but I'm hopeful that the technology will eventually be used wherever surgery is performed. OSM

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