Utilizing OR black box technology to identify and characterize intraoperative delays, distractions and threats in the gynecology operating room: A pilot study

Abstract

<h3>Objectives</h3> 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. <h3>Methods</h3> A cross-sectional study was conducted of 11 patients undergoing total laparoscopic hysterectomy (TLH) at a Canadian tertiary care hospital between May and October 2019. 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 technical and non-technical scores. <h3>Results</h3> Mean total case time was 172 (SD ± 16) minutes and mean procedure time was 117 (SD ± 17) minutes). 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. <h3>Conclusions</h3> The ORBB allowed us to identify variations in total case times and procedural times for elective TLH. There were frequent intra-operative distractions as well as latent threats noted and there was a moderately positive correlation between case times and procedure times and team non-technical skills.