Black boxes enter the OR

A data recording device famous for its use in airplane crashes is making its way into surgery rooms.  

Black boxes were made for the aviation industry to record everything about flights in real time and for future review – data points like speed and altitude along with the sounds of voices and the engine. The data was pivotal in showing aviation experts where they could improve. Part of their design was to be crash-proof so that if a plane went down, the black box would survive and give us valuable information that could protect us in the future.  

 Duke University is equipping their operating rooms with black boxes with the goal of improving quality of care. The black boxes record “basically, anything and everything,” says Christpher Mantyh, MD, Professor of Surgery and Chief Quality Officer for Duke University Medical Center.  

The system is designed to capture audio, video, and other data during a surgical procedure, allowing for later analysis and review. It also includes an artificial intelligence (AI) platform that uses machine learning algorithms to identify potential areas of improvement in surgical techniques and team communication. 

“The system integrates other numerical data and physiological data,” said Rebecca McKenzie, DNP, MBA, MSN, RN, Assistant Vice President of Perioperative Services of Duke University Hospital. 

 “It’s not only reviewing the video and the audio that was transpiring at the period of time you’re looking at, but there’s a feed from the physiological monitor and the anesthesia machine. So, the patient’s temperature, their oxygenation, and all of those sorts of things are tied in also.” 

So far, black boxes have helped Duke provide better patient care, increase patient turnover, and redesign operating room layout for efficiency.  

“When we look at the black box, we figure out exactly the right position to put everything: Where should the nurses and surgeons stand? Where do we put the trays? Where do the robot arms go?” Dr. Mantyh said. 

“We take an ergonomic look at everything, even the mopping, and make the room more efficient. It’s the same for our laparoscope equipment, which hangs on booms. We can look at the videos and say, ‘Maybe we should have the boom on the left side instead of the right.’ Or, ‘the anesthesia machine might be getting in the way.'” 

Duke began with black boxes in two operating rooms and has since expanded into more, but one area – emergency trauma rooms – remains untapped. 

“One area that is very chaotic is our trauma bays,” Dr. Mantyh said. “I remember as a resident way back when the trauma bay was the most chaotic area in the hospital. Obviously, time is of the essence. Patients can have a lot of things going on. But if you actually do it well, it is an amazingly efficient and potentially lifesaving area. So we’re thinking about putting [a black box] in there.” 

Duke is also looking to put black boxes in other departments like thoracic surgery, gynecology, and urology.  

Dr. Mantyh shared, “I think people are clamoring to see how we can do it better. I do think [the black boxes] are here to stay.”