The case for black boxes beyond the OR: Viewpoint

"Black boxes" in operating rooms are gaining popularity as a tool to improve safety and optimize efficiency. Given their benefits in this area, there is a significant opportunity for hospitals to improve patient safety by installing them in other high-risk settings, Mary Hawn, MD, wrote in a blog published on the Association of American Medical Colleges' website Oct. 3. 

OR black boxes, named after the recording devices on airplanes, continuously gather video, audio, patient vital signs and data from surgical devices. At Palo Alto, Calif.-based Stanford Hospital, where Dr. Hawn is a surgeon, the systems are in place in four operating rooms. Across the U.S., at least 24 hospitals are using the technology to review surgical teams' performance and improve efficiency.

At Stanford Hospital, the black boxes have been in use since June 2022 and have been particularly beneficial in reviewing surgeries and preventing harm, according to Dr. Hawn. She recalled a case in which a patient whose blood pressure dropped and heart suddenly stopped was avoided due to the quick action from the surgical team. 

After the patient's recovery, "our team had to ask certain crucial questions: Were we just lucky to have the right people in the right place to save her? Would we be able to save the next patient? Was there something we could have done better," Dr. Hawn said. 

"In this case, it allowed us to review how the team responded, how staff communicated with each other, who called for additional help, when help arrived and, ultimately, how long it took to stabilize [the patient]."

Outside of this, Dr. Hawn pointed to other uses for the technology to improve teamwork, educate providers and reduce errors. 

"Given their numerous benefits, it makes sense for hospitals to install such a system not only in their operating rooms but also in intensive care units, emergency departments and other high-risk areas," she said. 

Earlier this year, leaders at Durham, N.C.-based Duke University Hospitals told Becker's the system is looking to roll out the boxes to other areas, including trauma bays. 

Dr. Hawn and other leaders have acknowledged some staff members' concerns surrounding whether the recordings could be used to reprimand individuals for their performance, but they underscored that all recordings captured by the boxes are de-identified and are used solely for quality improvement. After 30 days, footage is deleted to protect the privacy and confidentiality of patients and healthcare providers.

"It's not about Jane or Joe's individual performance," Dr. Cleary previously told Becker's. "The whole spirit behind this system is to make things in the operating room work better. It's made to make things safer."

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