The case for a surgical 'black box' to prevent mistakes

Could 'open the floodgates' to malpractice lawsuits

Canadian researchers are working to develop a surgical "black box" that could analyze surgeons' movements and identify errors during an operation, Chethan Sathya writes for CNN.

Sathya is a surgical resident at the University of Toronto.

Details of surgical black box

According to research conducted by Teodor Grantcharov, a surgeon at St. Michael's Hospital in Toronto, surgeons make about 20 errors per surgery, but recognize few of their mistakes. He argues that a black box could be used as an "educational tool" to learn from these mistakes and identify their causes. It can also be used as a tool to prevent them from happening in the moment.  

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Grantcharov and his team of researchers are working on such a device. Although the concept of a black box for surgery is not new, the technology had never moved beyond the laboratory because it lack technological elements necessary to understand all the components of OR interaction.

 Grantcharov's box is a "multifaceted system" that includes room cameras and microphones that capture the surgeon's movements and the care team's dynamics. Among other things, the device could evaluate how surgeons stitch, how they handle organs, and how physicians communicate with their staff during surgery.

The box could provide instant feedback when errors are made, which could dramatically reduce surgical errors and postoperative complications. Specifically, the system would point out mistakes as they are being made and warn surgeons when they are veering "off course" during an operation or using techniques linked with high complication rates.

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Could a black box 'open the floodgates' to malpractice suits?

However, using the black box's recordings in court could "open the floodgates to a new wave of malpractice concerns," Sathya writes.

Although the Health Care Quality Improvement Act prevents courts from using information that hospitals use for peer review and self-regulation, cases where surgeries are recorded not peer reviewed can be used in court.

Teodoro Dagi of the American College of Surgeons Perioperative Care Committee argues that making black boxes a requirement in the OR could make surgeons nervous, which could harm patients. Dagi says, "The black box needs to be used solely by surgeons for their own education" and to improve their outcomes in the OR.

Richard Epstein of New York University School of Law disagrees. "I would rush (a black box) into service immediately," he says, arguing that not knowing exactly what happened in the OR fuels distrust of surgeons.

Similarly, William McMurry, president of the American Board of Professional Liability, says concerns about litigation should not deter surgeons from adopting black boxes in the OR. He says that while it is important for patients to know the details of their surgery—mistakes included—ultimately "the black box will provide surgeons with the information they need to avoid mistakes" and lead to "better health care."

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Test driving the black box

So far, the black box has been tested on about 40 patients undergoing bariatric weight-loss surgery. It will now be tested in hospitals in Canada, Denmark, and parts of South America. Some American hospitals could follow suit.

According to Sathya, the turnaround to implementation in the United States could be quick because the black box is not considered a medical device and does not require FDA approval (Sathya, CNN, 8/22). 

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