Operating Room Black Box Research Articles

Evaluating performance: a scoping review on video-based assessments of non-technical skills in the operating room

Background: Patient safety remains a critical concern in the high-stakes environment of the operating room (OR). Human factors and non-technical skills (NTS) play pivotal roles in surgical performance and in preventing errors. Various assessment tools and methodologies have been developed to evaluate NTS among OR personnel, reflecting the growing recognition of their importance. Objectives: To map and analyze NTS among OR personnel during real-life surgeries using medical video recording systems and to evaluate NTS assessment tools described in existing literature. Methods: Four databases, PubMed, Web of Science, Medline and Embase, were searched for relevant studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol was followed. Eligibility criteria included studies focusing on video recordings providing an overview of the entire OR with a focus on NTS. Results: Twenty-four articles were included in this scoping review. A total of eight NTS were assessed, most frequently communication (79%), leadership (54%), teamwork (50%) and situational awareness (50%). Observational methods varied, ranging from one or more cameras to more sophisticated medical data recorders, such as the OR Black Box (ORBB). Additionally, a wide variety of assessment methods were used, mostly validated tools (NOTSS, SPLINTS, ANTS), but also broader systems-based frameworks (SEIPS) or self-developed tools. Conclusions: This scoping review highlights the diverse methodologies used to measure NTS in the OR using medical video recordings, indicating a need for further research to address challenges and standardize practices. Despite the proven potential benefits of video recording in the OR, legal, ethical and logistical challenges may serve as possible barriers to actual implementation.

Impact of team performance on the surgical safety checklist on patient outcomes: an operating room black box analysis.

Surgical safety checklists reduce adverse events, but monitoring adherence to checklists is confounded by observation bias. The ORBB platform can monitor checklist compliance and correlate compliance with outcomes. This study aims to evaluate the association between checklist compliance and patient outcomes using the ORBB platform. This is a retrospective analysis of data from the electronic medical record of cases performed in ORBB-equipped operating rooms at a single quaternary referral center. All patients who did not opt out and underwent surgery at UT Southwestern Medical Center in ORBB-equipped rooms from August 2020 to September 2022 were included. The ORBB platform was set-up in five operating rooms and surgical safety checklist compliance was monitored by way of AI-based video review. Overall, 4581 patients were included in this analysis.. Performance on the checklist was associated with lower mortality (OR, 0.96; 95% CI, 0.94-0.98; P < 0.05), and decreased length of stay (estimate [E]: -0.02days; 95% CI, -0.03 to -0.005; P < 0.05). Performance during "timeouts" was associated with mortality (OR, 0.97; 95% CI, 0.94-0.99; P < 0.05). "Debriefings" were independently associated with mortality (OR, 0.98; 95% CI, 0.96-0.99; P < 0.05), length of stay (Estimate, -0.0009days; 95% CI, -0.02 to -0.001; P < 0.05), and ICU admission (OR, 0.99; 95% CI, 0.98-0.99; P < 0.05). Procedures performed by surgical teams who performed better on the surgical safety checklist tended to have better outcomes. This innovative technology could substantially enhance our ability to understand and mitigate threats to patients in real-time.

Operating room black box: GIMMICK or a patient safety tool?

The Operating Room Black Box (ORBB) is a relatively recent technology that provides a comprehensive solution for assessing technical and non-technical skills of the operating team. Originating from aviation, the ORBB enables real-time observation and continuous recording of intraoperative events allowing for an in-depth analysis of efficiency, safety, and adverse events. Its dual role as a teaching tool enhances transparency and patient safety in surgical training. In comparison to traditional methods, like checklists that have limitations, the ORBB offers a holistic understanding of clinical and non-clinical performances that are responsible for intraoperative patient outcomes. It facilitates systematic observation without additional personnel, allowing for review of numerous surgical cases. This review highlights the potential benefits of the ORBB in enhancing patient safety, its role as a surgical training tool, and addresses barriers especially in resource-constrained settings. It signifies a transformative step towards global surgical practices, emphasizing transparency and improved surgical outcomes.

Using the Operating Room Black Box to Assess Surgical Team Member Adaptation Under Uncertainty: An Observational Study.

Identify how surgical team members uniquely contribute to teamwork and adapt their teamwork skills during instances of uncertainty. The importance of surgical teamwork in preventing patient harm is well documented. Yet, little is known about how key roles (nurse, anesthesiologist, surgeon, and medical trainee) uniquely contribute to teamwork during instances of uncertainty, particularly when adapting to and rectifying an intraoperative adverse event (IAE). Audiovisual data of 23 laparoscopic cases from a large community teaching hospital were prospectively captured using OR Black Box. Human factors researchers retrospectively coded videos for teamwork skills (backup behavior, coordination, psychological safety, situation assessment, team decision-making, and leadership) by team role under 2 conditions of uncertainty: associated with an IAE versus no IAE. Surgeons identified IAEs. In all, 1015 instances of teamwork skills were observed. Nurses adapted to IAEs by expressing more backup behavior skills (5.3× increase; 13.9 instances/hour during an IAE vs 2.2 instances/hour when no IAE) while surgeons and medical trainees expressed more psychological safety skills (surgeons: 3.6× increase; 30.0 instances/hour vs 6.6 instances/hour and trainees: 6.6× increase; 31.2 instances/hour vs 4.1 instances/hour). All roles expressed fewer situation assessment skills during an IAE versus no IAE. OR Black Box enabled the assessment of critically important details about how team members uniquely contribute during instances of uncertainty. Some teamwork skills were amplified, while others dampened when dealing with IAEs. The knowledge of how each role contributes to teamwork and adapts to IAEs should be used to inform the design of tailored interventions to strengthen interprofessional teamwork.

Operating room black box: Scrutinizer of theatre practices

ObjectiveAdverse surgical events are a major cause of morbidity, mortality, and disability worldwide. The cause of many such events can be attributed to interruptions in the operating room (OR), multitasking by surgeons, etc. The objective of this study was to observe the types and frequency of intraoperative workflow interruptions in our ORs. MethodThis cross-sectional study was conducted from March to April of 2023. An observational approach using an audio-video recording device was employed to record OR flow disruptions. One elective OR and one emergency OR under the Department of General Surgery were selected for the study. All open and laparoscopic surgeries conducted in the selected ORs were included. An Internet Protocol camera was installed in the selected ORs with a view of the entire room, including the anesthesia station. Audio-video recording was started after the first incision and stopped after closure of the surgical site. ResultOf the 51 cases that were studied, 45 (88.2%) were elective, and 18 (35.3%) were laparoscopic cases. They could be classified into 8 types of open procedures and 4 types of laparoscopic procedures. The mean maximum headcount inside the OR was 15.5 ± 3.6 and doors opened on average of 15.8 ± 6.0 times during a procedure. Other interruptions were surgeons attending phone calls (24, 47.1%), leaving the sterile area (21, 41.2%), technical disturbances (32, 62.7%), anesthetic interruptions (18, 35.3%), and faulty instruments (29, 56.9%). Elective procedures had a significantly higher average number of interruptions per operating hour than emergency procedures (17.5 ± 8.6 vs. 7.1 ± 2.9, p < 0.01). ConclusionPreventable factors such as faulty instruments, anesthetic interruption, and attending phone calls by the surgeon are commonly observed in ORs. They need to be addressed by timely surgical audits or the adoption of continued surveillance methods that can help take measures to minimize their occurrence.

Interprofessional staff perspectives on the adoption of or black box technology and simulations to improve patient safety: a multi-methods survey

IntroductionMedical errors still plague healthcare. Operating Room Black Box (ORBB) and ORBB-simulation (ORBBSIM) are innovative emerging technologies which continuously capture as well as categorize intraoperative data, team information, and audio-visual files, in effort to improve objective quality measures. ORBB and ORBBSIM have an opportunity to improve patient safety, yet a paucity of implementation literature exists. Overcoming implementation barriers is critical. This study sought to obtain rich insights while identifying facilitators and barriers to adoption of ORBB and ORBBSIM in alignment with Donabedian’s model of health services and healthcare quality. Enrichment themes included translational performance improvement and real-world examples to develop sessions.MethodsInterprofessional OR staff were invited to complete two surveys assessing staff’s perceptions using TeamSTEPPS’s validated Teamwork Perceptions Questionnaire (T-TPQ) and open-ended questions. Descriptive statistics were calculated for quantitative variables, and inductive phenomenological content analysis was used for qualitative.ResultsSurvey 1 captured 71 responses from 334 invited (RR 21%) while survey 2 captured 47 responses from 157 (RR 29.9%). The T-TPQ score was 65.2, with Communication (70.4) the highest construct and Leadership (58.0) the lowest. Quality Improvement (QI), Patient Safety, and Objective Case Review were the most common perceived ORBB benefits. Trends suggested a reciprocal benefit of dual ORBB and ORBBSIM adoption. Trends also suggested that dual implementation can promote Psychological Safety, culture, trust, and technology comfort. The need for an implementation plan built on change management principles and a constructive culture were key findings.ConclusionsFindings supported ORBB implementation themes from previous literature and deepened our understanding through the exploration of team culture. This blueprint provides a model to help organizations adopt ORBB and ORBBSIM. Outcomes can establish an empirical paradigm for future studies.

Artificial intelligence-enabled operating room data analysis: Current and future prospects for enhancing surgical safety

Despite advances in medical technology, intraoperative adverse events (IAE) continue to occur in hospital’s complex systems. Current approaches to understanding and mitigating IAEs rely on retrospective data analyses to recognize the series of events leading to an IAE. This paper discusses current challenges and highlights the potential of the Operating Room Blackbox (ORBB) system use to enhance patient safety.

Enhancing M&M rounds with the OR black box: A case of uterine perforation at hysteroscopy

Surgical complications happen, but it is essential to review these events to learn how to optimize care and avoid similar situations in the future. The Operating Room (OR) black box is a new technology that records audio and video footage from the operating room which is analyzed to improve patient care. It is also a promising tool to enhance morbidity and mortality rounds by reviewing surgical complications with real-time footage of the adverse event and context in which it happened. This video reviews the operating room (OR) black box, its functions and utility in enhanced morbidity and mortality rounds. A case of uterine perforation at hysteroscopy is presented using OR black box footage in the style of an enhanced morbidity and mortality rounds to demonstrate its utility and review important safety considerations for hysteroscopy.

MP68-19 USE OF THE OR BLACK BOX® TO EVALUATE OPERATING ROOM ECONOMIC EFFICIENCY

You have accessJournal of UrologyCME1 Apr 2023MP68-19 USE OF THE OR BLACK BOX® TO EVALUATE OPERATING ROOM ECONOMIC EFFICIENCY Leah Beland, Arun Rai, and Louis Kavoussi Leah BelandLeah Beland More articles by this author , Arun RaiArun Rai More articles by this author , and Louis KavoussiLouis Kavoussi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Operating room (OR) utilization is a key component of economic considerations utilized by OR directors and hospital administrators. Case-start times and turn over time can significantly impact OR utilization and overall economic efficiency. The OR Black Box® (ORBB) is a recording platform that integrates both audio and visual recordings of the operating room and procedure. We utilized information from the ORBB to identify factors that impact OR utilization as well as compliance with safety protocols. METHODS: This is a prospective analysis of OR utilization at a tertiary academic health center using a novel data capture device designed for use in the OR. Information from the ORBB of three busy ORs were reviewed from February 7 to September 4 of 2022 to evaluate case on-time starts, block utilization, turnover time, and compliance with pre-procedural ‘time out’ safety checklists. Block utilization was defined as the percentage of block time used to perform surgical procedures. The turn-over times were compared to national averages provided by the ORBB platform wherein the device is currently in utilization. RESULTS: Data from 1,348 cases were included for analysis. Average turnover time for this 142-day period across the three ORs was 46 minutes, which is above the 38-minute national average for all ORs equipped with the ORBB. This increased turnover time equated to 30-31 hours of overtime (calculated as time over the ORBB median turnover time), which amounts to approximately $13,000-186,000 of additional labor costs over the network average. On average, there was 67% block utilization time across the 3 ORs. For all ORs, cases started on time 68% of the time with case delays ranging from 42 to 62 minutes. However, when looking at urology cases only, cases had a 100% on-time rate. From a safety checklist standpoint, 97% of cases had a time-out completed correctly per hospital policy. CONCLUSIONS: Data derived from the ORBB allows for assessment of OR utilization and adherence to safety protocols. This data is critical from a health management standpoint to ensure judicious use of hospital resources. Further data is needed to understand factors prolonging turn-over time as well as factors that enable on-time start among services such as urology at our institution in order to optimize OR economic efficiency. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e961 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leah Beland More articles by this author Arun Rai More articles by this author Louis Kavoussi More articles by this author Expand All Advertisement PDF downloadLoading ...

Amplifiers and Dampeners of Patient Safety Risk in the Operating Room: Interim Analysis of Surgical Video Recorded with the Operating Room Black Box

Preventable intraoperative adverse events (iAEs) may emerge from interactions between multiple work system factors (WSFs) (e.g., technology design, organizational policy, physical environment); these interactions may amplify or dampen patient safety risk. We conducted an exploratory observational study using audiovisual data captured by the Operating Room Black Box to characterize the relationships between associated WSFs. Human factors specialists reviewed video recordings of surgical procedures before transcribing events of interest and classifying them into the relevant WSF categories as defined by the Systems Engineering Initiative for Patient Safety model. Each WSF code was categorized as either a safety threat (ST) or resilience support (RS), and their interactions with associated WSFs were characterized. We transcribed 706 events over 73.5 hours of surgery, and 32 iAEs were identified. We coded 382 STs and 312 RSs, and 249 co-occurring WSF pairings. Co-occurring team (e.g., clear communication, feedback, and leadership) RSs were found to be the most prevalent mechanism to dampen all categories of ST. Co-occurring task (e.g., challenging anatomy) and environment (e.g., disruptive working environments, suboptimal ergonomic monitor setups) STs were the most common risk amplifiers contributing to the occurrence of iAEs. By assessing WSFs in the context of other WSFs, future research may develop interventions that more precisely target risk reduction in the operating room.

Identifying positive and negative use of non-technical skills by anesthesiologists in the clinical operating room: An exploratory descriptive study

BackgroundTeamwork is a critical competency in high-risk settings like the operating room (OR). While conventional approaches focus on describing and learning from negative performance, there may be value in learning from high-performing behaviour, particularly in specialties where serious safety events are relatively rare. This study aimed to explore both the positive and negative use of non-technical skills by anesthesia practitioners in the OR and situate them within the clinical OR context. MethodsThis study employed a prospective observational design. Following research ethics approval, a sample of surgical cases in a tertiary hospital were recorded using the OR Black Box®. Data related to surgical phase timing, non-technical skills, team factors, and environmental factors were identified by analysts according to a modified Systems Engineering Initiative for Patient Safety model. We performed descriptive statistics and qualitative description of these observations. ResultsWe observed 25 surgical cases capturing 242 instances of positive non-technical skills among anesthesiologists in the operating room and 9 instances of negative demonstrations. Situational awareness was most frequently (n = 160) observed, followed by communication and teamwork skills (n = 82), and were most often demonstrated in the context of potential environmental distractions (e.g., doors opening, unnecessary interruptions). The least common category of positive non-technical skills observed was leadership (n = 3). ConclusionsOur findings show anesthesiologists are doing a lot “right” and there may be many opportunities for learning from positive practice in the clinical setting. These findings can inform future work to better understand and standardize best practices for non-technical performance in anesthesia.

Healthcare professionals’ perception of safety culture and the Operating Room (OR) Black Box technology before clinical implementation: a cross-sectional survey

IntroductionComprehensive data capture systems such as the Operating Room Black Box (OR Black Box) are becoming more widely implemented to access quality data in the complex environment of the OR....

The Operating Room Black Box: Understanding Adherence to Surgical Checklists.

We report for the first time the use of the Operating Room Black Box (ORBB) to track checklist compliance, engagement, and quality. Implementation of operative checklists is associated with improved outcomes. Compliance is difficult to monitor. Most studies report either no assessment of checklist compliance or deployed in-person short-term assessment. The ORBB a novel artificially intelligence-driven data analytic platform affords the opportunity to assess checklist compliance without disrupting surgical workflow. This was a retrospective review of prospectively collected ORBB data. Operative cases included elective surgery at a quaternary referral center. Cases were analyzed as prepolicy change (first 9 months) or as a postpolicy change (last 9 months). Measures of checklist compliance, engagement, and quality were assessed. There were 3879 cases that were performed and monitored for checklist compliance between August 15, 2020, and February 20, 2022. The overall scores for compliance, engagement, and quality were 81%, 84%, and 67% respectively. When broken down by phase, the scores for time-out were compliance 100%, engagement 98%, and quality 61%. Scores for the debrief phase were 81% for compliance, 98% for engagement, and 66% for quality. After a hospital policy change, the debrief scores improved significantly (85%; P <0.001 for compliance, 88%; P <0.001 for engagement and 71%; P <0.001 for quality). ORBB provides the unprecedented ability to assess not only compliance with surgical safety checklists but also engagement and quality. Utilization of this technology allows the assessment of compliance in near real time and to accurately address safety threats that may arise from noncompliance.

Characterizing and Contextualizing the Use of the Surgical Safety Checklist in General Surgery

The Surgical Safety Checklist (SSCL) is a widely implemented intervention; however, limited studies have explored system factors that impact adherence to proper checklist completion. Using an audio-visual recording technology called the Operating Room Blackbox (ORBB), the goal of this study was to characterize the level of checklist completion and identify work system factors that impact the use of the SSCL in general laparoscopic surgery. Thirty-six cases captured by the ORBB in a hospital in Toronto, Ontario were reviewed using an SSCL audit tool to collect data on item-level adherence. The Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model was applied to the observation notes from the ORBB recordings to identify work system factors influencing checklist use. On average, across all 36 cases, 8 of the 29 checklist items were completed (30.1%), with debriefing being completed most frequently of the 3 checklist sections. Of the 29 checklist items, commonly completed items were: patient concerns addressed, surgical counts complete, and procedure name, while items in the timeout section were completed the least. Notably, factors related to person (e.g., confirmation of patient information amongst surgical team) and tools and technology (e.g., use of checklist in combination with patient chart) were identified as facilitators to checklist use, while factors relating to tasks (e.g., redundancy of checklist items with existing workflow), tools and technology (e.g., some checklist items not applicable to some procedures), organization (e.g, timing of checklist items and absence of team member), and internal environment (e.g., music volume in the OR) were identified as potential barriers to checklist use. By understanding how system factors contribute to checklist use and item-level adherence, we can identify ways to improve the checklist to meet the needs of the OR team and enhance integration of the SSCL into existing workflows.

Assessing endovascular team performances in a hybrid room using the Black Box system: a prospective cohort study.

The hybrid room (HR) is a complex, high-risk environment, requiring teams (surgeons, anesthesiologists, nurses, technologists) to master various skills, including the 'As Low As Reasonably Achievable' principle of radiation safety. This prospective single center cohort reports the first use of the Operating Room Black Box (ORBB) in a HR. This medical data recording system captures procedural and audio-visual data to facilitate structured team performance analysis. Patients planned for endovascular repair of an infrarenal abdominal aortic aneurysm (EVAR) or treatment of symptomatic iliac-femoral-popliteal atherosclerotic disease (Peripheral Vascular Interventions or PVI) were included. Validated measures and established assessment tools were used to assess (non-)technical skills, radiation safety performance and environmental distractions. Six EVAR and sixteen PVI procedures were captured. Technical performance for one EVAR was rated 19/35 on the procedure-specific scale, below the 'acceptable' score of 21. Technical skills were rated above acceptable in all PVI procedures. Shared decision making and leadership were rated highly in 12/22 cases, whereas surgical communication and nurses' task management were rated low in 14/22 cases. Team members rarely stepped back from the C-arm during digital subtraction angiography. Radiation safety behavior was scored below 'acceptable' in 14/22 cases. A median (interquartile range) number of 12 (6-23) auditory distractions was observed per procedure. The ORBB facilitates holistic workplace-based assessment of endovascular performance in a HR by combining objective assessment parameters and rating scale-based evaluations. Strengths and weaknesses were identified in team members' (non-)technical and radiation safety practices. This technology has the potential to improve vascular surgical practice, though human input remains crucial. (NCT04854278).

Step, Error, and Event Frameworks in Endovascular Aortic Repair

Objective: Competency-based surgical education requires detailed and actionable feedback to ensure adequate and efficient skill development. Comprehensive operative capture systems such as the Operating Room Black Box (ORBB; Surgical Safety Technologies, Inc), which continuously records and synchronizes multiple sources of intraoperative data, have recently been integrated into hybrid rooms to provide targeted feedback to endovascular teams. The objective of this study is to develop step, error, and event frameworks to evaluate technical performance in elective endovascular aortic repair (EVAR) comprehensively captured by the ORBB (Surgical Safety Technologies, Inc; Toronto, Canada). Methods: This study is based upon a modified Delphi consensus process to create evaluation frameworks for steps, errors, and events in EVAR. International experts from Vascular Surgery and Interventional Radiology were identified, based on their records of publications and invited presentations, or serving on relevant journal editorial boards. In an initial open-ended survey round, experts were asked to volunteer a comprehensive list of steps, errors, and events for a standard EVAR of an infrarenal aorto-iliac aneurysm (AAA). In subsequent survey rounds, the identified items were presented to the expert panel to rate on a 5-point Likert scale. Delphi survey rounds were repeated until the process reached consensus with a predefined agreement threshold (Cronbach α>0.7). The final frameworks were constructed with items achieving an agreement (responses of 4 or 5) from greater than 70% of experts. Results: Of 98 invited proceduralists, 38 formed the expert consensus panel (39%), consisting of 29 vascular surgeons and 9 interventional radiologists, with 34% from North America and 66% from Europe. Consensus criteria were met following the third round of the Delphi consensus process (Cronbach α=0.82–0.93). There were 15, 32, and 25 items in the error, step, and event frameworks, respectively (within-item agreement=74%–100%). Conclusion: A detailed evaluation tool for the procedural steps, errors, and events in infrarenal EVAR was developed. This tool will be validated on recorded procedures in future work: It may focus skill development on common errors and hazardous steps. This tool might be used to provide high-quality feedback on technical performance of trainees and experienced surgeons alike, thus promoting surgical mastery.

Perceptions of safety culture and recording in the operating room: understanding barriers to video data capture.

Recording in the operating room is an important tool to help surgical teams improve their performance. This is becoming more feasible using the Operating Room Black Box, a comprehensive data capture platform. Operating room (OR) staff, however, may voice reasonable concerns as recording initiatives are implemented. The objective of this study was to assess pre-implementation attitudes of OR staff toward operative recording and explore the relationship of these attitudes to the themes of (1) safety culture, (2) impostor syndrome, and (3) privacy concerns. This cross-sectional survey study measured staff members' beliefs and opinions of operative recording and used three previously validated tools (safety attitudes questionnaire, clance impostor phenomenon scale, and dispositional privacy concern) to assess personal and professional factors. Concepts were correlated using Pearson's correlation coefficient. Forty-three staff members participated in this study, with a response rate of 45% (n = 43/96, 20/22 nurses, 9/11 gynecologists, 14/63 anesthesiologists). Opinions of operative data capture were generally positive (5-point Likert scale, mean = 3.81, SD = 0.91). Nurses tended to have more favorable opinions of the OR Black Box as compared to gynecologists and anesthesiologists, though this did not reach statistical significance (4.15 vs. 3.67 vs 3.43, p = 0.06). Impostor syndrome characteristics correlated with concerns about litigation related to recording (r = - 0.32, p = 0.04). There are personal and professional attributes of the OR team that impact perceptions of the OR Black Box and implications around privacy and litigation. Addressing these concerns may facilitate successful implementation of the OR Black Box and improve team communication and patient safety in the OR.

Utilizing the Operating Room Black Box to Characterize Intraoperative Delays, Distractions, and Threats in the Gynecology Operating Room: A Pilot Study.

IntroductionOperating Room Black Box (ORBB) technology can be used to capture information during surgery for analysis and potential identification of root causes that jeopardize safety and efficiency. In this study, our objective was to identify and characterize procedural steps, intraoperative distractions, errors, and threats, as well as the non-technical skills of the team during a common minimally invasive gynecologic procedure.MethodologyThis was a cross-sectional pilot study of 25 patients undergoing total laparoscopic hysterectomy between May 2019 and February 2020 at a Canadian tertiary care academic hospital. Video, audio, and patient physiologic data from all procedures were obtained through a multichannel synchronized recording device (ORBB). Trained analysts reviewed and coded the recordings.ResultsThe median total case time was 165 minutes (interquartile range [IQR]: 160-178 minutes) with the shortest step being cystoscopy and the longest being vaginal cuff closure. Time pressure and device absence or malfunction occurred in 48% of the cases, and a median of 262 (IQR: 228-304) auditory distractions were noted per case. There was a median of 3 (IQR: 2-4) safety threats identified per case and at least one error was identified in 11/25 cases (44%). Only two adverse events were noted among all 25 cases. Observed non-technical skills were mainly positive, and observations were the highest for situational awareness and leadership among the surgical team and communication and teamwork among the nursing/scrub technician and anesthesia teams.ConclusionsThis study is a novel application of the ORBB in the gynecology operating room to capture information regarding procedure times, intraoperative distractions, errors, and non-technical skills of the team. Frequent intraoperative cognitive and auditory distractions were noted. Although adverse events were rare, safety threats were identified. Ongoing and future research from our group will aim to identify key areas for organizational, technological, and team improvement to minimize inefficiencies and optimize patient safety in the operating room.

Implementation of the Operating Room Black Box Research Program at the Ottawa Hospital Through Patient, Clinical, and Organizational Engagement: Case Study.

BackgroundA large proportion of surgical patient harm is preventable; yet, our ability to systematically learn from these incidents and improve clinical practice remains limited. The Operating Room Black Box was developed to address the need for comprehensive assessments of clinical performance in the operating room. It captures synchronized audio, video, patient, and environmental clinical data in real time, which are subsequently analyzed by a combination of expert raters and software-based algorithms. Despite its significant potential to facilitate research and practice improvement, there are many potential implementation challenges at the institutional, clinician, and patient level. This paper summarizes our approach to implementation of the Operating Room Black Box at a large academic Canadian center.ObjectiveWe aimed to contribute to the development of evidence-based best practices for implementing innovative technology in the operating room for direct observation of the clinical performance by using the case of the Operating Room Black Box. Specifically, we outline the systematic approach to the Operating Room Black Box implementation undertaken at our center.MethodsOur implementation approach included seeking support from hospital leadership; building frontline support and a team of champions among patients, nurses, anesthesiologists, and surgeons; accounting for stakeholder perceptions using theory-informed qualitative interviews; engaging patients; and documenting the implementation process, including barriers and facilitators, using the consolidated framework for implementation research.ResultsDuring the 12-month implementation period, we conducted 23 stakeholder engagement activities with over 200 participants. We recruited 10 clinician champions representing nursing, anesthesia, and surgery. We formally interviewed 15 patients and 17 perioperative clinicians and identified key themes to include in an information campaign run as part of the implementation process. Two patient partners were engaged and advised on communications as well as grant and protocol development. Many anticipated and unanticipated challenges were encountered at all levels. Implementation was ultimately successful, with the Operating Room Black Box installed in August 2018, and data collection beginning shortly thereafter.ConclusionsThis paper represents the first step toward evidence-guided implementation of technologies for direct observation of performance for research and quality improvement in surgery. With technology increasingly being used in health care settings, the health care community should aim to optimize implementation processes in the best interest of health care professionals and patients.

OR black box and surgical control tower: Recording and streaming data and analytics to improve surgical care.

Effective and safe surgery results from a complex sociotechnical process prone to human error. Acquiring large amount of data on surgical care and modelling the process of surgery with artificial intelligence's computational methods could shed lights on system strengths and limitations and enable computer-based smart assistance. With this vision in mind, surgeons and computer scientists have joined forces in a novel discipline called Surgical Data Science. In this regard, operating room (OR) black boxes and surgical control towers are being developed to systematically capture comprehensive data on surgical procedures and to oversee and assist during operating rooms activities, respectively. Most of the early Surgical Data Science works have focused on understanding risks and resilience factors affecting surgical safety, the context and workflow of procedures, and team behaviors. These pioneering efforts in sensing and analyzing surgical activities, together with the advent of precise robotic actuators, bring surgery on the verge of a fourth revolution characterized by smart assistance in perceptual, cognitive and physical tasks. Barriers to implement this vision exist, but the surgical-technical partnerships set by ambitious efforts such as the OR black box and the surgical control tower are working to overcome these roadblocks and translate the vision and early works described in the manuscript into value for patients, surgeons and health systems.