Archive Hottest Trends 2015

'Black Box' in Every OR

Surgery can take a lesson from aviation, says the surgeon who invented a device that records every step of surgery.

Teodor Grantcharov, MD, PhD


monitors the performance CLOSE WATCH Any high-risk industry monitors the performance of the frontline workers. Surgery should be no different.

Flight data recorders embedded on airliners retrace the events that led to mid-air disasters. I've developed the same "black box" technology for the OR to find out why adverse events happen and what can be done in the future to improve patient safety. But the technology has broader applications. My goal is place a black box in every OR, including yours, to enhance surgical outcomes, improve case efficiencies and lower healthcare costs.

Moments in time
The black box platform, which is about the size of a tissue box or thick book, records almost everything that happens in the OR during laparoscopic surgeries. It 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, as well as potential distractions: how often the OR door is opened and how many times phones ring or ping.

Surgical teams can use the black box to zero in on specific moments during cases to check the patient's vital signs, listen in on what the surgical team was discussing and watch the surgeon's technique. Yes, they can use the technology to determine what led to a surgical error, but they can also analyze the captured moments of time to assess how procedures could have been performed better or more efficiently.

Proprietary software syncs the inputs to timestamp every event that occurs during a procedure, allowing for post-op analysis of the many different factors that contribute to outcomes, successful or otherwise. Currently, most of the analysis is automated, but our goal is to automate the entire information-gathering process and send the data to a central database designed for tracking trends that help predict risk of future hazards and quantify surgeon performance in order to develop effective coaching interventions. Surgeons will have the clinical data they need for better coaching and technique improvement, to reduce the risks of surgery and sidestep avoidable complications, to ultimately provide better patient care. The surgical team will notice the little things they can do to improve overall procedural efficiencies, which will save facilities money and allow them to schedule more cases.

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