Install “Black Box” Technology in Operating Rooms

Black boxes would make surgery more transparent and perhaps safer as a result.

When air­line dis­as­ters occur, inves­ti­gat­ing teams imme­di­ate­ly turn their atten­tion to loca­tion of the “black box­es” con­tain­ing flight infor­ma­tion and cock­pit voice record­ings. Peo­ple want to know what hap­pened. Pub­lic safe­ty demands trans­paren­cy. It would be unthink­able for the air­line indus­try or gov­ern­ment agen­cies to with­hold infor­ma­tion, or to dis­play a lack of inter­est in learn­ing what hap­pened so that it could be pre­vent­ed from occur­ring again.

In hos­pi­tals, sur­gi­cal errors and infec­tions that occur after surgery are too-frequent occur­rences. The same kinds of errors are reg­u­lar­ly repeat­ed. In the U.S., it is esti­mat­ed that more than 2,000 times every year, sur­geons oper­ate on either the wrong patient or on the wrong site.  In 2013, 157,000 infec­tions fol­lowed sur­gi­cal pro­ce­dures.  Canada’s rate of leav­ing sponges and tow­els in patients, and caus­ing unin­tend­ed lac­er­a­tions dur­ing surgery is the worst among indus­tri­al­ized nations.  Sig­nif­i­cant harm can arise from sur­gi­cal errors, which are gen­er­al­ly pre­ventable.

It is said that health­care has much to learn from the avi­a­tion indus­try when it comes to safe­ty.  If that is the case, why not insist that all hos­pi­tal oper­at­ing rooms be fit­ted with the equiv­a­lent of “black box” data and voice tech­nol­o­gy?  We would add to this, video record­ing capa­bil­i­ty which is eas­i­ly avail­able with the minia­tur­iza­tion of cam­eras. This would elim­i­nate the myr­i­ad of ques­tions that arise when some­thing goes wrong in surgery.  Today, most of those ques­tions are nev­er answered.  It is impor­tant to learn from these errors so that they can be avoid­ed in the future. Since the same kind of mis­takes are made over and over again,  it is clear that new learn­ing tech­niques need to be embraced in the clin­i­cal set­ting.

The Cen­ter for Patient  Pro­tec­tion urges the adop­tion of manda­to­ry black box tech­nol­o­gy in hos­pi­tal oper­at­ing rooms.