Utilizing Black Box Technology to Identify and Describe Intraoperative Delays, Distractions and Threats in the Gynecology OR: A Pilot Study

Abstract

Study Objective Operating room delays can result from a chain of intra-operative events including technical factors, equipment failures or unavailability, and non-technical human factors. Operating Room Black Box (ORBB) technology can be used to capture information during surgery for analysis and potential identification of root causes of inefficiencies. Our objective was to measure and characterize procedural steps, intra-operative distractions and delays during a common minimally invasive gynecologic procedure and identify if these delays correlated with team technical and non-technical scores. Design Cross-sectional study. Setting Canadian tertiary care academic hospital. Patients or Participants Eleven patients undergoing total laparoscopic hysterectomy (TLH) between May and October 2019. Interventions Video, audio, and patient physiologic data from all procedures were obtained through a multichannel synchronized recording device. Trained analysts reviewed the recordings and coded procedural timing, distractions, delays, threats and team technical and non-technical scores. Measurements and Main Results Mean total case time was 172 minutes (SD +/- 16 minutes) and mean procedure time was 117 minutes (SD +/- 17 minutes). Mean surgical times for the pre-operative, intra-operative and post-operative phases were 85 mins (SD ± 40 mins), 116 mins (SD ± 17 mins) and 28 mins (SD ± 16 mins) respectively. Correlations between total case time and team non-technical scores and procedure time and team non-technical scores were positive and moderate in strength. Medians of 83 door openings [interquartile range (IQR) 76-104], 173 distractions (IQR 19-190) and 3 threats (IQR 2-5) were identified per case. Conclusion The ORBB allowed us to identify variations in procedural case times for elective TLH. There were frequent intraoperative distractions as well as latent threats noted and there was a moderately positive correlation between case times and team non-technical skills.