Consulting the OR Black Box

"We want to understand things that we do well and understand things we don't do so well."
"[We need to] make sure that if we make mistakes in the operating room, these mistakes are no longer repeated."
"[The black box project found that when there were many people in the room, the number of] interoperative errors and adverse events [doubled]."
"It showed us that with a simple intervention — reducing the number of unnecessary people in the operating room — we were able to bring down ... the number of errors." 
"It improved the attitudes towards safety. Not only the doctors and nurses, but the entire OR team."
"The most common response I hear from my patients is, 'I can't believe this hasn't been done before'."

Teodor Grantcharov, professor of surgery, University of Toronto, staff surgeon, St. Michael's Hospital, Toronto

Three years ago, a Toronto hospital installed its first black box in an operating room. Now the doctor behind that project is bringing the devices to hospitals in Ottawa    (CBC)

"We don't want to wait for a complication to understand what happens. We want to systematically identify behavior at risk of complication."
"Every clinician comes to work every day to provide the best possible care for their patients. That's their number one goal. And so any opportunity to improve care is usually welcomed."
"[Twenty years ago] There was a lot of training on how to stitch a wound, how to insert a catheter, but almost nothing on non-technical skills such as teamwork."
"Today medical staff receive more training in these areas, but we don't know whether it's making a difference to patient outcomes."
"The goal [with the black box project] is to learn from our current practices and see what we can improve." 
Dr. Sylvain Boet, black box project lead researcher, anesthesiologist, The Ottawa Hospital 

Dr. Sylvain Boet. OTTwp

"The operating room is like a black box. We don't necessarily know what is going on inside as patients when we are under the knife and anesthesia."
"It [data derived from analyzing black boxes] is a good tool to help improve patient safety."
"I was really glad to learn The Ottawa Hospital is engaging in this sort of patient-oriented research strategy."
"The fact that as patients our voices were heard and we were respected gives us a sense of pride and we feel valued."
Maxime Le, patient adviser, The Ottawa Hospital

Maxime Le had heard about the black box initiative in Toronto, installed in several hospitals there, headed up by Dr. Teodor Grantcharov at St. Michael's Hospital. Mr. Le had studied health sciences and communications; his academic background has led to his keen interest in this new project whereby black boxes are being installed in hospital operating rooms, to be played back post-surgery and analyzed with respect to how that surgery was conducted, and what its outcome was, and whether changes of any kind would be beneficial to patient outcome.

Mr. Le had himself in recent years undergone three surgeries. After his experiences and with his background in health sciences, he felt a compulsion to contribute what he could to the hospital once it was brought to his attention that the hospital uses the advice of patient advisers. He made application to join a team of patient advisers for assistance in implementing the black box program.

A black box has been installed in an operating room at the Ottawa Hospital with the goal of making surgery safer.

The program itself is derived in principle from the installation of black boxes on aircraft where a record of all critical aspects of the flight are to be found. After all aircraft incidents or accidents, incident researchers look for the location of the black box to unlock the secrets of whatever went wrong which led to an untoward incident, to determine whether the fault lay with the plane itself, with technical faults of any kind, or whether human error or/and extreme weather conditions played a role when things went awry.

The more data that is available, collected from any source to be examined after the fact, the better investigators are enabled to understand the circumstances involved and causation, and to recommend a way forward to improve performances for the future, be it air flight or operating room procedures. The black box collects data from cameras, audio recorders, along with vital signs exhibited by the patient and other critical information. In the case of the operating room black box the goal is to improve communication.

Seen as a key to operating room safety, communication and the part it plays in advancing a smooth performance while not traditionally emphasized in medical school training, communication is critical to success. So much so that research concludes teamwork [and my implication communication] is a factor in up to two-thirds of surgical complications. The research project with the installation of black boxes in operating rooms is meant to identify practices that may lead to complications.

Dr. Teodor Grantcharov is the creator of the OR black box. It records nearly everything in the OR, including video of the surgical procedure, conversations among health-care workers, room temperature and decibel levels. (Photo by Yuri Markarov)