Researchers at St. Michael's Hospital in Toronto have developed a “black box” for use in operating rooms, similar to that used in the airline industry.

Teodor Grantcharov, M.D., said the goal is to improve patient safety and outcomes by identifying where errors occur in the OR and teaching surgeons how to prevent them. He said that when black boxes were introduced in the aviation industry, preventable errors dropped significantly.

Grantcharov has been testing the prototype of his black box in the operating rooms at St. Michael’s, where he specializes in advanced minimally invasive surgeries, such as gastric bypasses. It’s also being tested at two hospitals in Copenhagen, Denmark, with more international sites to be involved soon.

The box is about the size of a box of tissues or a thick book and it records almost everything that goes on in the OR, such as video of the surgical procedure, conversations among health care workers, room temperature and decibel levels. It works only for laparoscopic, or minimally invasive, surgeries that insert video cameras in thin plastic tubes into small incisions in the body that allow the surgeon to see what’s going on inside the patient.

“We want to see where errors happen in surgery so that we can understand how errors lead to adverse events and develop training curricula to prevent these errors from ever happening again,” Grantcharov said.

He said research has already shown that 84 percent of errors in bypass surgery happen during the same two steps, so training has been adapted to help surgeons master those two skills.

Grantcharov said he’s looking at performance issues--something the surgeon did or didn’t do, such as apply enough force when grabbing a bowel, which might make it slip and tear. But he’s also looking at less tangible factors that can lead to errors, such as communication and team dynamics.

He also noted that professional athletes have coaches who point out their wrong moves and help them improve their performance.

“For surgeons, we will have data that will allow better coaching and improvements and therefore better patient care,” said Grantcharov. “We will reduce the risk and complications and show how to make the OR more efficient, which will also allow us to save money and do more cases.”

Ultimately, it is hoped the black box will bring more transparency to the OR for patients and help change the culture that traditionally has made doctors and nurses reluctant to report mistakes.

A video demonstration of the technology is available here.

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