Black boxes, like the ones used in airplanes, record surgeons’ movements to provide analysis and identification of errors to prevent potential patient complications.
Mention the term “black box,” and aviation accident investigation probably comes to mind. But soon, similar devices may also be installed in operating rooms to improve surgical procedures. A group of researchers, led by Dr. Teodor Grantcharov of Toronto’s St. Michael’s Hospital, is working on developing a surgical black box system that can monitor and record surgical techniques and communications in the operating room. The goal is to reduce errors, prevent surgical complications and reduce associated costs.
The system uses a number of cameras and microphones to record surgical technique, as well as communications and dynamics in the operating room environment. This gives surgeons the ability to review the film and data later—in a more relaxed environment—so that the effectiveness of surgical procedures may be improved. The system is still in development, but preliminary results have proven that making small changes in the operating room can significantly impact patient outcomes.
The inspiration for the “surgical black box” was indeed drawn from the airline industry, as evidenced by consultations with Air Canada to learn how aviation investigators reconstruct accidents to identify mistakes and reduce them. Grantcharov says medicine can learn a lot from aviation’s example: “The similarities are that there is a human performance and there is a technology (devices or aircrafts) and we need to really understand how these two interact and how we can create teaching or training interventions, or safety-enhancing interventions to predict risks proactively, and find ways to mitigate all these risks.”
In this interview, he notes a primary reason for use of the black box—the lack of ongoing supervision and “coaching” for surgeons once they complete their training, and the need for procedural transparency to optimize ongoing learning:
The surgical black box promises to be a great platform for learning and training for the medical community, but concerns about use for negative purposes could make some surgeons uncomfortable about adoption. Dr. Sacha Bhatia, director of the Institute for Health Systems Solutions and Virtual Care at Women’s College Hospital and advisor to Ontario’s Ministry of Health and Long-Term Care says finger-pointing and legal issues could be an issue: “The blame and shame question is a big one, and the big spectre of medical-legal. If something happens, are these black boxes going to be used to potentially impact a legal case?” The potential could affect a surgeon’s ability to perform optimally in the operating room environment. However, Grantcharov appeals to surgeons to take inspiration from the airline industry’s ability to use the black box for higher purposes: “Changing the culture starts with admitting or being transparent about our deficiencies.”
The team is working on further improving the system to deliver data to surgeons in real time to warn them if they use improper technique before mistakes are made. Though Grantcharov’s current version of the black box can only be used in laparoscopic procedures, he hopes to integrate Google Glass to expand the application. With the use of Glass, more surgical procedures could be included, surgeons could receive feedback directly through the computerized eyewear, and consults with other surgeons could be supported. The system is also being tested in two hospitals in Copenhagen, Denmark—and more international sites are on the horizon. The potential for remote collaboration and process improvement is significant—especially for regions such as the GCC, which is rapidly ramping up healthcare development. With the ability to take part in surgical procedures virtually, surgeons across the world could soon be working side by side.
