INNOVATION FUND Technology and AI in Healthcare Quality and Safety SHOWCASE 2019

Enhancing surgical care and outcome through education and knowledge translation: Implementation of the Operating Room Black Box® and exploration of intraoperative teamwork

Quality and Safety

Sylvain Boet

613-797-8899 x 78187

The Ottawa Hospital and The Ottawa Hospital Research Institute

Glenn Posner

613-798-5555 x18912

The Ottawa Hospital


TOH-17-002 This project involved successful implementation of the innovative OR Black Box® (which records audio, video, and physiological data) to improve quality of care and patient safety in the OR. Since The Ottawa Hospital was one of the first centres in the world to adapt the OR Black Box®, the team worked to develop a comprehensive implementation plan tailored to the local context. The current study uses the OR Black Box® to investigate teamwork in the OR and identify potential areas for improvement. This is a practical and sustainable way to decrease intraoperative errors, promote patient safety, and improve health outcomes. Since teamwork is related to a large proportion of preventable errors in the OR, this work has the potential to greatly reduce surgical complications and related healthcare costs.


TOH-17-002 Almost every Canadian will undergo surgery at least once in their lives; 1 in 10 will experience complications resulting from intraoperative errors. In 2 out of 3 cases, ineffective teamwork in the operating room (OR) is a primary contributing factor. Yet, research on OR teamwork is limited by inadequate data on clinical performance and the lack of a standardized assessment tool. The OR Black Box® is an innovative technology that could overcome these limitations. Similar to black boxes used in the aviation industry, the device records audio, video, and physiological data from the OR. We aimed to 1) implement the OR Black Box® at an academic hospital and 2) analyze teamwork in the OR. 1) Implementation-Phase 1a: We conducted interviews to explore stakeholder perceptions toward being recorded by the technology. Phase 1b: Themes from the interviews were incorporated into a hospital-wide information campaign informing patients and staff about the OR Black Box®. Phase 1c: We conducted two systematic reviews to identify the most valid and reliable tools for assessing teamwork in various clinical contexts. Three tools were identified based on their measurement properties: NOTECHS, OTAS, and TEAM. 2) Teamwork analysis-Phase 2a: We are currently collecting data using the OR Black Box® to determine which of the tools is best for clinical OR teamwork assessment. Phase 2b: We will use the selected assessment tool to describe the range of teamwork performance in the OR and identify areas for possible improvement. This project will allow us to systematically learn from teamwork performances, addressing current evidence-practice gaps and existing limitations in performance-tracking mechanisms. It will provide the foundation for novel quality and safety interventions to ultimately improving surgical patient safety.

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