Using the OR Black Box to Characterize Intraoperative Delays, Distractions, and Threats

This study applied OR Black Box® technology to analyze total laparoscopic hysterectomy procedures at a Canadian tertiary care academic hospital. The researchers examined 25 cases between May 2019 and February 2020, using multichannel synchronized recording to capture video, audio, and patient physiologic data. Their objective was to identify and characterize procedural steps, intraoperative distractions, errors, threats, and the team's non-technical skills during this common minimally invasive gynecologic procedure.

The findings revealed a median total case time of 165 minutes, with vaginal cuff closure being the longest step. Notably, 48% of cases experienced time pressure and device-related issues. The study identified a high frequency of auditory distractions, with a median of 262 per case. Safety threats were observed in all cases, with a median of 3 per procedure, and errors were noted in 44% of cases. Despite these challenges, adverse events were rare, occurring in only two cases. The team's non-technical skills were generally positive, with high marks for situational awareness and leadership among surgeons, and strong communication and teamwork among nursing and anesthesia staff. This pilot study demonstrates the potential of the OR Black Box to identify areas for improvement in operating room efficiency and patient safety in gynecological procedures.