Posted by Bill Sandweg on 18 March 2019.
A little over four years ago, I wrote about a Canadian surgeon who had developed a “black box” to monitor events in the operating room and warn surgeons and nurses if they were deviating from best practices. The goal was to improve the quality of the surgery and prevent medical malpractice.
Most people know what a “black box” is in the context of commercial airliners. The black box records in real time a number of flight parameters such as airspeed, altitude, attitude and control positions. In the event of an accident, the black box can provide invaluable information about what happened and how to prevent a similar accident in the future.
I predicted at the time of my earlier post that the idea of an operating room black box would be opposed by the very surgeons it was attempting to help. That prediction, which unfortunately required little insight on my part, has proved true. While commercial airline pilots, who have hundreds of lives in their hands, have their every move monitored, surgeons in the operating room complain that they would be too nervous if they knew a black box was watching and recording what they did. They were afraid that the recording system would provide proof of their conduct, should they commit malpractice during the surgery. Turns out they may have good reason to be concerned.
The Canadian surgeon who pioneered the idea of the surgical black box has continued his work. Last year, he and his colleagues published a report of their experience during the first year of testing the black box concept. The researchers followed 132 consecutive patients undergoing laparoscopic procedures at their academic hospital. An academic hospital is one which has a residency training program. Their findings were interesting.
Among their significant findings was that there were errors and distractions in every case. Auditory distractions ranged from a minimum of 96 to a maximum of 190. An auditory distraction is an irrelevant sound that has the potential to interfere with attention and decision making. The median number of auditory distractions was 138. Errors were frequent and often went unnoticed by the surgeon at the time. The median number of errors for each surgery was 20. Some surgeries had as many as 36. The fewest number of errors in a surgery in the study was 14. Errors occurred most often during the dissection and reconstruction phases of the surgery. These are scary numbers.
The researchers were also able to compare the performance of surgery residents, who were in training, against the performance of experienced surgeons. To no one’s surprise, the experienced surgeons exhibited better technical skills than their trainees.
It is good to have objective data such as this. The black box here can perform the same function it does after an airplane accident. The surgeons and the residents can learn what they did wrong and avoid those mistakes in the future. It is time for the medical profession to get over its obsession with keeping its performance a secret from its patients and the public and embrace new technologies that will improve patient safety.