Patient Safety Tip of the Week Archive

What’s New in the Patient Safety World

June 2023

WSJ on Video Recording in the OR

We’ve long been advocates for use of video recording, particularly in the OR. Video recording can be used constructively to assess communication and teamwork in the OR. It can be used evaluate OR door opening and closing, which may be factor contributing to surgical site infections. It can help quantitate interruptions and distractions that occur during procedures and identify some of the reasons for those interruptions and distractions. It can be used to determine compliance with Universal Protocol, surgical timeouts, surgical checklists and whether parties were truly active participants in those important processes. It can help determine whether all parties are actively participating in sponge/instrument counts. In our March 2019 “Another Use for Video Recording” we showed how it has been used to demonstrate compliance with key steps in specific surgical procedures. And it can obviously be used to assess and improve performance in medical education and training.

A recent Wall Street Journal article (Sadick 2023) highlighted use of OR “black boxes” at Mayo Clinic and Duke.

Duke University Hospital is using the technology to study and improve patient positioning for surgery to reduce the possibility of skin-tissue and nerve injuries. It’s also being used to improve communication among nursing personnel and ensure that key tasks during a procedure are being completed promptly, effectively and efficiently. Duke has also used the technology to improve specimen handling and OR turnaround times.

The article also interviewed a physician leader at the University of Texas Southwestern Medical Center and an NYU attorney about some of the challenges of implementing black box systems. At UT Southwestern, chief quality officer William Daniel noted some operating-room personnel at first were apprehensive that data might be used for punitive purposes but, after they were reassured about “how data would be collected and used, it quickly became an accepted part of the hospital's culture", emphasizing it is designed to focus on improving systems, not assigning blame. But Richard Epstein, the NYU Law Professor, noted black boxes are an untested area legally, and that "Legal protections are not clearcut and are uncertain until tested by litigation and/or legislation." On the other hand, David L. Feldman, chief medical officer at Healthcare Risk Advisors, a New York City-area company working with hospitals on how to reduce malpractice risk, said that the anonymization of information from the OR Black Box makes it unlikely to be used in malpractice litigation.

WSJ writer Barbara Sadick did a good job outlining both the potential benefits of OR black box recording and the challenges and barriers involved.

We hope you’ll also go back to our many columns, listed below, on use of black box recording in the OR.

Some of our previous columns discussing video recording:

September 23, 2008 “Checklists and Wrong Site Surgery”

December 6, 2010 “More Tips to Prevent Wrong-Site Surgery”

November 2011 “Restricted Housestaff Work Hours and Patient Handoffs”

March 2012 “Smile...You’re on Candid Camera!”

August 27, 2013 “Lessons on Wrong-Site Surgery”

March 17, 2015 “Distractions in the OR”

November 24, 2015 “Door Opening and Foot Traffic in the OR”

March 2019 “Another Use for Video Recording”

March 17, 2020 “Video Recording in the OR”