Operating Room Black Box Increases Patient Safety

Pilot of surgical recording system at UTSW has exceeded expectations, providing an unprecedented level of data.

UT Southwestern aimed to enhance safety, surgical outcomes, and efficiency when it introduced the OR Black Box to William P. Clements Jr. University Hospital in Dallas in 2020. The system, which captures data on multiple aspects of a surgery, has far exceeded expectations.

“Not only has it improved safety, survival, and length of stay for patients, it has strengthened surgical teams,” says William Daniel, M.D., Vice President and Chief Quality Officer. “It has done a remarkable job.”

The OR Black Box, developed by Surgical Safety Technologies Inc. (SST) in Toronto, was originally installed in five UT Southwestern operating rooms as part of a three-year pilot. It was so effective that today the system is in 38 ORs at Clements University Hospital, where it has recorded almost 70,000 hours of surgical cases. This has given UT Southwestern more experience with the OR Black Box than anywhere else in the world.

“With the OR Black Box in every room, the amount of data we are getting is unprecedented,” says Herbert Zeh, M.D., Professor and Chair of Surgery. “It allows us to measure things that we were never able to measure accurately before.”

Improving Performance

Data from the OR Black Box is fed into computer servers, then electronically relayed to SST, which uses artificial intelligence and trained analysts to evaluate issues such as the proper use of safety checklists. Each month, SST relays its findings to UT Southwestern. That data is then used to conduct quality-improvement meetings at which OR team members review the reports.

“It is almost like a game film,” Dr. Zeh says, referencing how professional sports teams study video of games to improve their strategies.

“One of the things we realized early on was that when people were counting instruments and needles, they were getting interrupted,” Dr. Daniel says. “Now we make sure we perform ‘timeouts’ during every case, when we pause and make sure the entire team is engaged.”

Tags and Flags

The system’s patient identity-protected video clips have provided insight into surgical “tagged and flagged” events. Tagging is used to raise awareness of something that is atypical, such as a longer procedure. Flagging highlights potential problems or outstanding achievements.

“The most transformational items have been the tags and flags,” Dr. Zeh says.

Drs. Zeh and Daniel stress that the goal of the system is to identify areas of continued improvement and recommend best practices.

“From the beginning, we made it abundantly clear that this was not being used punitively,” Dr. Daniel says. “The reason we have it is to help ourselves get better.”

While avoiding patient harm is paramount, recognizing a job well done is also important.

“It gives people a chance to celebrate each other,” Dr. Daniel says. “When you see someone make a great catch, you see that esprit de corps.”

Leading the Way

The OR Black Box has been well-received by patients. During the pilot, 97% of patients agreed to its use.

“We are a leading academic medical center, and our patients expect that we would be innovative and lead the way in safety practices,” Dr. Daniel says.

In line with high-reliability organizations such as NASA, UT Southwestern is dedicated to quality improvement. The OR Black Box is another way to further that commitment to safety.

“We are already leaders,” Dr. Zeh says. “I think that with time, some devices like this will be in every OR in the country.”

William Daniel, M.D., Vice President and Chief Quality Officer

Herbert Zeh, M.D., Professor and Chair of Surgery