The Toronto Star
October 1, 2013
A Toronto doctor is taking his cues from the aviation industry in an effort to help surgeons become better at what they do.
Teodor Grantcharov M.D., has invented an "operating room (OR) black box" that records all aspects of an operation and helps identify where surgeons make errors.
"We register very, very minor deviations from the perfect situation. There is no procedure with zero," says the St. Michael's Hospital surgeon, who specializes in minimally invasive procedures.
Grantcharov's creation is part of a pilot study. He began using it in his own surgeries earlier this year, and surgeons in Denmark plan to start testing it out soon.
Grantcharov hopes to publish results of the study in a peer-reviewed medical journal next year, and in a few weeks he will describe how it works to contemporaries at the American College of Surgeons conference in Washington, D.C.
If the OR black box concept flies, it could revolutionize the way surgery is done around the world.
"I'm just testing the concept in my OR at this point. My vision is to use this in every OR, for every surgeon and surgical team. We all have to constantly learn and constantly improve," says Grantcharov, an associate professor of medicine at the University of Toronto.
The black box recordings are similar to those already possible today, he explains. Grantcharov does a lot of laparoscopic surgery, using a monitor to see where his laparoscope is moving inside a patient's body. That can easily be recorded.
The black box also takes visual and audio recordings of the entire team involved. The success of operations is about more than the performance of the surgeon, he explains.
What is new and different is the analysis done afterwards: "On our research team, we have people who are experts in analysis of technical skills, we have experts who can analyze team performance. We can analyze other things like the safety of equipment and human factors."
It's during this assessment that errors are pointed out. They could be as minor as a surgeon momentarily losing sight of a suturing needle. Or as major as grasping a bowel too hard and causing a perforation.
Jeff Kolbasnik, M.D., past president of the Ontario Association of General Surgeons, says he likes the idea of anything that will improve patient safety and quality of care. "(But) potential negative consequences need to be assessed as well," he cautions. Kolbasnik wonders if the black box would make healthcare professionals feel as though "they are constantly being watched" and if that, in turn, would add stress to the already stressful OR. “What impact would that have on the success of surgeries?” he wonders.
Kolbasnik also wonders if and how the black box could be used in litigation and says its introduction may require a legislative framework.
Grantcharov stresses that the main purpose of the black box is educational.
"All of us can do things better. I have learned a lot from this project and I notice there are things I can do better," he says.
Grantcharov takes pains to emphasize that it's not intended to be punitive. "It's important to get this message out. We are not looking for a blame and shame tool. We are looking for a tool to help us be better," he tells a reporter.
However, like airliner black boxes, they could also be used to assess what went wrong after an accident, known in the OR as a "major adverse event."
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