Northwell Health’s ORs take cue from aviation industry
“GOOD MORNING, TORONTO,” says Dr. Louis Kavoussi, chair of urology at Northwell Health, with a laugh, leaning forward to speak into a microphone. “I wonder what the weather is like up there.”
Kavoussi isn’t actually speaking to anyone in Toronto. He’s trying to make his surgical team more comfortable with a new data-collection system from a company based there—one that includes video and audio recording in the operating room. It’s meant to better inform quality-improvement initiatives by identifying common surgical errors and variability between procedures.
There’s no nationwide system for reporting adverse events causing death or serious harm, making it difficult to pin down the frequency and cost of preventable medical errors. But some studies estimate medical errors as the third leading cause of death in the U.S., costing the nation roughly $17.1 billion.
The new system at Northwell, dubbed the OR Black Box and developed by Surgical Safety Technologies, ingests information from traditional monitors, like those documenting a patient’s physiological data, as well as adding data from new technologies set up around the OR, such as video cameras and microphones.
It’s “basically trying to gather all of what goes on in the OR,” said Dr. Mark Jarrett, Northwell’s chief quality officer.
Dr. Teodor Grantcharov, Surgical Safety Technologies’ founder and a general surgeon, modeled the system after aircraft “black boxes,” officially called flight data recorders, which capture what happens in the moments before a crash. The system collects vast amounts of data in the OR, then Surgical Safety Technologies uses artificial intelligence to deduce patterns—such as flagging near-misses and distractions. Those behaviors are reviewed by a team of surgeons before sending a report to Northwell’s quality team.
Grantcharov stresses to customers that the OR Black Box can’t assess individual performance and advises clients not to use the data to discipline clinicians.
Northwell is the first U.S. healthcare organization to use the OR Black Box. In Canada and Europe—where the technology launched in 2014 and 2016, respectively—it has helped identify common surgical errors and distractions. In one Canadian hospital, the system found OR doors opened roughly once every two minutes.
Northwell’s quality team maps out possible improvement initiatives based on data collected by the OR Black Box, though it hasn’t launched any yet. So far, the laparoscopic urologic and colon surgical teams at Long Island Jewish Medical Center have piloted the system for about a year, and they’re evaluating where to deploy next. “It took time to get it off the ground, to get comfortable— and you need enough cases that you can look for patterns,” Jarrett said.
When Northwell launched the pilot of the system, clinicians were skeptical. There was some “concern that this would be used in a punitive manner, as opposed to an educational manner,” said Kavoussi, who was the first Northwell surgeon to use the system.
Northwell’s quality team took a few steps to help make staff more comfortable, like showing staff that the OR Black Box blurs faces from videos and distorts voices from audio, as well as de-identifies names of patients and clinicians.
Kavoussi took a more playful approach to ease skepticism. “I started talking to it,” he said, suggesting that—by joking with the system—that it was a helpful presence in the room. He noted one key data point is how often nurses leave the OR to get supplies. Since using the system, he’s been more diligent about checking in with medical staff to make sure the room is properly prepped.
Setting up cameras in the OR for quality improvement is a somewhat new phenomenon, said Dr. Edward Pollak, medical director and patient-safety officer at the Joint Commission. While it’s standard to collect physiological patient data during a procedure, the video component has prompted concerns over patient privacy and staff comfort.
Pollak cautioned that collecting data is just a first step of any quality-improvement initiative. Without a strong process to make that information actionable, more data collection just adds cost.
“We have so much data right now that we already capture,” he said. “The real question is, what are you going to do with that information?” ●