U of T researcher on why a black box in the OR is good for health care

Most of us are familiar with the purpose of a black box on an airplane flight: It records audio from the cockpit and captures relevant data so that when something goes wrong, investigators are able to determine what happened and prevent future failures. 

Researchers believe black boxes could have a similar impact if adopted in the operating room.

Patricia Trbovich, an associate professor at the Institute of Health Policy, Management and Evaluation at the Dalla Lana School of Public Health, is leading a team of researchers in studying data captured by black boxes that have been introduced into Canadian operating rooms. Her team reviews everything from recordings of the surgical procedure and conversations among health-care workers to data about room temperatures and decibel levels.  

She and a team of analysts code the data looking for uncertainty variables and human factor elements at play, such the types of tools being used, the environment, technological malfunctions, and staffing shortages. The OR Black Box can also identify where surgical teams excel, and identify best practices that could be brought to other hospitals.

“The OR Black Box is not meant to be a punitive measure for surgeons,” said Trbovich (pictured left), the Badeau Family Research Chair in Patient Safety and Quality Improvement at North York General Hospital, which is now using the OR Black Box as part of the newly created Steinberg Family Surgical Safety Program.

 “We want to be able to see whether standard operating procedures are being followed and, if not, understand why this may be the case.” 

Most of the time, events recorded during the surgery are unrelated to the skill of the surgeon, involving instead the management of  uncertainty precipitated by a technical malfunction, such as the misfiring of a stapler, or environmental distractions, like noise from phone calls or the opening and closing of the door to the operating room.

Trbovich’s team has also identified factors that ensure surgeries continue smoothly despite challenges, such as when surgical team members delegate tasks to manage workload or have backup instrumentation prepared if needed. Events like these are coded each time they occur, creating an event matrix that allows analysts to look for patterns of behaviour or other factors that can be changed to better support surgical teams in the future.

“This is revolutionizing the way we study safety,” said Trbovich, adding that “it is creating a reliable record of data we can use to improve care, while also signifying the importance of a blame-free culture.”

The operating room black box is the brainchild of St. Michael’s Hospital’s Dr. Teodor Grantcharov. The device is used primarily during laparoscopic or other minimally invasive surgeries that involve the insertion of a small camera into a patient’s body. Patients must provide consent before being recorded, and any videos are erased after a period of 30 days.

Much in the same way athletes might watch clips of their performance to examine their mistakes, or strategize about ways they might improve, Grantcharov’s OR Black Box is designed to help surgeons benefit from being able to observe their performance, prevent future mistakes and pinpoint ways they might improve.

“What is novel about the OR Black Box is that it also is able to record new or creative ways that a surgical team may have conducted a procedure despite an uncertainty,” said Trbovich. “We have not been able to collect this type of data on a consistent basis before.”

While coding for uncertainty is largely done manually, Trbovich’s team has recently received Natural Sciences and Engineering Research Council of Canada and Ontario Centre of Excellence grants to support a more automated process. 

“By training the system to detect events automatically, the hope is that the OR Black Box will proactively identify where risks exist and hospitals will be able to implement interventions before they lead to an adverse event for patients,” said Trbovich.