A Canadian doctor is recording surgeries in his operating room because he wants to track errors in the OR to improve patient safety.
Dr. Teodor Grantcharov has been testing the prototype, consisting of cameras and microphones that record every move of the scalpel and all the words spoken in the OR during keyhole surgical procedures at St. Michael’s Hospital in Toronto.
Grantcharov was inspired by the "black boxes" that the aviation industry uses to investigate crashes. Surgery is a source of medical errors, but the profession doesn’t have the same tradition of looking for errors and ways to correct them.
"With the data, we will probably be able to identify what are the most dangerous steps of every surgical procedure," Grantcharov said. "If we can proactively predict the steps, and if we can prepare our team to maximize their attention and performance during these steps, I think we can eliminate many hazards in the operating theatre."
Every surgery includes small errors, but that doesn’t mean that a patient’s safety is compromised, he said. Rather, an error is the smallest deviation from a perfect course.
A pilot project involving about 80 gastric bypass surgeries has shown some results.
"We found quite surprisingly that 86 per cent of the errors happen during the same two steps of the surgical procedure," Grantcharov said.
The "black box" is blue and about the size of a laptop. It’s been in use at the hospital since late April. For patient privacy reasons, the raw data is deleted after 30 days.
Advice from Air Canada
Grantcharov turned to Air Canada for advice on how to use the device constructively and how to interact with members of the team, based on how pilots and flight crews use the data to improve safety and reduce costs.
'It may well be that in most cases, it is going to show that the doctors did absolutely nothing wrong.' - Alan Rachlin, lawyer
Sholom Glouberman, president of Patients Canada, which advocates for patient safety, said he thinks the OR black box is a terrific idea, but he expressed concern about looking solely to technology for solutions.
"The only concern I have is that many of these ideas continue and persist in leaving the patient out of things, as if surgery is a technical thing between the surgeon and patient's body without them being involved at all," Glouberman said.
Alan Rachlin, a Toronto lawyer who represents medical malpractice clients, said he welcomes the OR black box and the more objective record it could provide.
"It cuts both ways," Rachlin said. "It may well be that in most cases, it is going to show that the doctors did absolutely nothing wrong. It could [also] help the patient."
Evidence suggests that when patients are involved in the development of changes to health care delivery, then outcomes are better, Glouberman said.