The OR Black Box as a Novel Tool to Improve Surgical Safety and Education

Errors are prevalent in medicine and frequently lead to increased morbidity and mortality for patients. The complex environment within the operating room, and the multiple people and teams involved in providing patient care, make surgery especially prone to error. Healthcare relies on incident reports, morbidity and mortality (M and M) rounds, and review of patient charts to retrospectively determine factors that contributed to severe errors or near misses.1 Unfortunately, these methods focus primarily on incidents that result in significant patient harm and are subject to recall bias and poor capture of details surrounding key factors or events. Often, many seemingly minor contributions or incidents that do not lead to harm are deemed irrelevant and are not adequately assessed or are omitted altogether. The OR Black Box is a novel system of cameras, monitors, and audio recorders that captures everything that happens in the operating room to allow for future assessment of all errors that occur during a case. Such capture and assessment enable surgeons to review all intraoperative errors and determine what factors lead to errors so they can be avoided in future. The OR Black Box can also be used as an educational tool to facilitate surgical trainee feedback and review of surgical skills. Routine and widespread use of the OR Black Box has the potential to improve surgical safety and training and is a promising new tool for healthcare advancement.