In an operating room at Long Island Jewish Medical Center, a collection of video cameras, microphones and other sensors monitor the scene, from the delicate surgical procedure to the number of times a doctor’s phone rings.
The hospital in New Hyde Park says it is the first in the nation to use a virtual black box, designed to record information used to evaluate systems, improve safety and head off errors.
“There’s been a slowing in the advancement of safety in the operation room over the past couple of decades,” said Dr. Louis Kavoussi, chair of urology for the Zucker School of Medicine at Hofstra/Northwell, who has used the technology in his Long Island Jewish Medical Center operating room for the past year. “Yes, there have been improvements in sterilization techniques and operating techniques, but the actual mechanisms to pick up errors has really inched along.”
The OR Black Box was developed by Dr. Teodor Grantcharov, a Canadian surgeon and scientist leading a team of researchers at the International Centre for Surgical Safety at St. Michael’s Hospital in Toronto.
It is being used at nine other hospitals in Canada and Western Europe, and will expand to a second room at Long Island Jewish Medical Center this month.
“One of the biggest barriers for improvement in health care was lack of data,” Grantcharov said. “We developed systems that could measure the performance of the surgeon, the team, the devices, the state of the patient and other factors.
"In addition, we can measure how the patient is doing. Now we can for the first time bring all those data feeds together."
While the data from a year’s worth of procedures at Long Island Jewish Medical Center are still being crunched, Kavoussi said preliminary reports have provided some interesting findings about common noise, interruptions and distractions in operating rooms.
“It shows that there's a lot of traffic going in and out of the room,” Kavoussi said. “And a lot of this is because we don't necessarily keep all the equipment in a room we need for an operation.”
Any time a person enters or exits an operating room, there is a potential risk for bringing bacteria into the space, he noted. Having equipment on hand also can shorten the time a patient is under anesthesia by about 15 minutes, Kavoussi said.
The use of music during procedures, often thought to create a relaxing atmosphere for surgeons and staff, also can be a distraction as it conjures up memories, he said.
“You are thinking about how you danced with your significant other to that song, and that flashes in your head as opposed to Mrs. Jones' gallbladder, [which] needs to move to the right or the left,” he said.
Kavoussi said he personally eschews playing music while performing surgery.
“There’s a cadence to an operation, a pace,” he said. “So if you are playing music, the tempo changes and cadence has to change.”
Grantcharov said the data are de-identified to protect the privacy of the patient, doctor and staff. Their faces are blurred and voices altered. The recordings are not archived, but the information culled from them goes into a database. Grantcharov said the raw video and audio data are automatically deleted in 30 days.
Northwell officials said the data are protected from lawsuits because it is part of quality control measures.
Northwell pays about $100,000 per operating room to Surgical Safety Technologies, a private company started by Grantcharov, for the OR Black Box equipment. Officials said the cost of the contract to analyze the data are confidential.
Video and audio information of each procedure, along with other data, are transmitted to Canada, where they are analyzed by artificial intelligence algorithms and clinical experts at Surgical Safety Technologies. The information and insights derived from the recordings are to be used to improve operating room protocols.
“It’s not to examine whether a surgeon has a great technique or a bad technique because most surgeons do pretty well technically,” said Dr. Mark Jarrett, chief quality officer for Northwell Health. “Most things that go wrong are not related to the direct technique, but other things going on in the operating room. This is designed to look at system issues rather than specific people issues.”
Jarrett said when patients sign consent forms before procedures and operations, they state that there may be recordings made for quality control purposes. Both officials at Northwell Health and Grantcharov said the OR Black Box information is not available to patients.
The seeds of the OR Black Box started when Grantcharov started videotaping his procedures as a surgical resident.
“I noticed there were so many things I thought I did extremely well, but then when I looked back I saw so many things I could do better,” he said.
The first OR Black Box prototype was developed in 2014. Since then, Grantcharov and his team have worked with engineers and computer scientists to refine the system.
Jarrett reached out to Grantcharov several years ago, intrigued by his work. He approached Michael Goldberg, executive director of Long Island Jewish Medical Center about a pilot project.
“This was an incredible innovation and could give us insight into improvement,” Goldberg said. The first OE Black Box was installed at Long Island Jewish Medical Center in early 2019.
As more information is fed into the OR Black Box database, computers will be able to better evaluate systems, Kavoussi said. He foresees a time when the OR Black Box will be able to work in real time instead of recording data.
“This is the initial application of artificial intelligence in the operating room," Kavoussi said. “It will be amazing to come into the operating room, have a computer assess what’s going on and give recommendations.”