Could the Use of ‘Black Boxes’ in Operating Rooms Assist in Malpractice Cases?

Surgical and other hospital errors are unfortunately a common occurrence in Canada. A 2004 study published in the Canadian Medical Association Journal called “The Canadian Adverse Events Study”, found that 187,500 out of 2.5 million patients admitted each year to Canadian acute care hospitals experience an adverse event, which can range from a fall to an infection, or even death. Of those who suffer an adverse event, between 9,000 and 23,000 Canadians die each year because of preventable adverse events. Surgical errors are the single largest source of these events, amounting to 34% of the total.

For several years now, a medical research team in Toronto has been developing and implementing the use of what is referred to as a ‘black box’ in surgical theatres and operating rooms in Ontario. According to a CTV news article, the idea was taken from the use of similar devices in airplanes, which record activity in the cockpit and can help provide insight into crashes or other flight mishaps. Dr. Teodor Grantcharov, a Canada Research Chair in Simulation and Surgical Safety at the University of Toronto, as well as a staff surgeon at St. Michael’s Hospital in Toronto decided to take the idea of recording activity in a plane and apply it to the operating room. The intention behind the idea was to track and find patterns of distraction that can have a negative effect on the outcome of a surgery, with an eye to putting protocols into place designed to limit those distractions and improve patient care going forward.

Background of the Project

Dr. Grantcharov had noted the fact that distractions occur on a regular basis in an operating room, which can lead to complications including excessive bleeding or patient injury. Noting that other, non-medical yet detail-oriented professions had procedures in place to eliminate distractions when total concentration was most crucial, he thought the application of similar procedures could be helpful in a surgical setting. In particular, he drew comparisons to an airplane cockpit during takeoff and landing. He noted that there are specific protocols in place to eliminate distractions to the pilots during crucial moments of a flight, such as a complete ban on non-operational conversation during those times (this is referred to as a “sterile cockpit”).

In order to properly assess the changes needed to reduce preventable mistakes in the operating room, the team designed a black box consisting of cameras and microphones to be placed in the surgical suite to record everything from the surgery itself to the ambient noise in the room and the comings and goings of various staff.

Key Findings to Date

The team was surprised at the level of distraction they found overall. In particular, surgical teams regularly engaged in off-topic, social conversations throughout a surgery, and the surgeons involved in the studies reported being distracted in 44% of the cases. In general, the team identified a number of overall issues, including:

  • An average of 95 distracting noises per surgery, from alarms, bells and telephones in the room
  • Device malfunctions, which occurred in 35% of cases
  • Operating room doors opened and closed an average of 41 times and stayed open for an average of 3 minutes each time per surgery, which not only served as a distraction but could also allow infectious agents to permeate the sterile operating environment

From this, the team began to develop protocols to improve the safety of an operating room, such as ‘time outs’, which enable any surgical team member to call for a time out, resulting in immediate quiet in the room.

The recordings have also helped team members identify critical moments in various types of surgeries, where mistakes are most likely to occur. For example, in a study of 80 gastric bypass surgeries, the team found that “86 percent of the errors happen during the same two steps of the surgical procedure”. Identifying these critical moments in different surgeries will enable teams to devise similar protocols to the “sterile cockpit” concept when concentration is most crucial, in an attempt to reduce the most common errors. Further, it provides data on areas where additional training could help to reduce the occurrence of some of the most common mistakes.

What Role Could Black Boxes Play in Medical Malpractice Claims?

For now, the project is aimed at helping hospitals develop policies and practices to reduce surgical errors and distractions, however, many are wondering how these black box recordings could offer assistance in medical malpractice lawsuits. A detailed recording of a surgical procedure could be a revelation in pinpointing the cause of an error, or whether an error was made. The research team is not in favour of the system being used in litigation, however, these recordings could serve to assist both patients and medical professionals in cases going forward were they made accessible.

A recording of this type could provide an objective way to measure exactly what occurred during surgery and whether one or more parties are at fault; similar to how dashboard cameras have revolutionized the apportioning of fault in a motor vehicle accident. For patients who are not conscious during a procedure, and therefore at an inherent disadvantage, this system could provide much-needed information on what exactly occurred if they became injured during surgery. For surgeons and other professionals, it may help to absolve them of liability if there is evidence that they performed their duties properly and any negative outcome was beyond their control.

We will continue to follow any developments in this area. In the interim, if you believe you suffered an injury due to surgical or hospital error, we can help. Contact the lawyers at Sommers Roth & Elmaleh to find out what options are available for you and your family. We have represented parents, children, and their families in a number of ground-breaking medical malpractice lawsuits and have obtained significant compensation for many individuals who have suffered lasting and/or serious injury as a result of physician error or malpractice. Call us at 1-416-961-1212 or contact us online for a free, no-obligation consultation.

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