'Black boxes' make their way into hospital ORs

Twenty-four hospitals in the U.S., Canada and Western Europe are using "black boxes" — named after the recording devices in airplanes — to collect and analyze operating-room practice data in hopes of reducing medical errors and improving patient safety and operating room efficiency, The Wall Street Journal reported March 19.

The OR Black Box, made by Surgical Safety Technologies in Toronto, gathers video, audio, patient vital signs and data from surgical devices during surgery. Audio and video are deidentified, giving participants blurred faces and cartoonish bodies, according to the report. Hospitals can use the data to view performance over time or to analyze particular operations.

Mayo Clinic has used the device in three operating rooms over the last year in order to improve surgical safety and outcomes, according to Susan Hallbeck, PhD, professor of healthcare systems engineering at Rochester, Minn.-based Mayo Clinic's Kern Center for the Science of Health Care Delivery.

Durham, N.C.-based Duke University Hospital has installed OR Black Boxes in two operating rooms to study and improve patient positioning to reduce skin tissue and nerve injuries and to improve communication among nurse personnel during surgical procedures. The boxes have helped the system identify a need for a better sending and tracking system for specimens, Rebecca McKenzie, DNP, RN, assistant vice president for perioperative services at Duke University Hospital, told the Post. The Duke teams have also found new ways to increase operating room efficiency and productivity by reducing the amount of time to prepare an operating room for the next procedure. The health system is considering using the box as a teaching tool for nurses' OR training, she said.

The University of Texas Southwestern Medical Center in Dallas is using five black boxes to understand the characteristics of a high-performing operating room team.

However, some worry the black boxes could be used to assign blame and punishments.

"Aggregate data is deidentified and anonymized so we can learn from it now and in the future, and audiovisual data is deleted after 30 days to protect the privacy and confidentiality of patients and healthcare providers," Surgical Safety Technologies founder Teodor Grantcharov, MD, PhD, a professor of surgery and practicing surgeon at Stanford Medicine, said in the article.

Others worry the information could be used in lawsuits; however, there has not yet been a case where this information was requested or used in court.

The anonymization of information from the OR Black Box makes it unlikely to be used in malpractice litigation, David Feldman, MD, chief medical officer at Healthcare Risk Advisors, a New York City-area company working with hospitals on how to reduce malpractice risk, said in the report.

"I believe it will make surgery safer and thus reduce liability and malpractice claims," he said.

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