Leadership style can dramatically impact the culture of safety. This analysis of video-recorded endovascular procedures found that surgeons’ transformational leadership style (e.g., motivation/enthusiasm, individual consideration, emphasis on the collective mission) positively impacts team behaviors such as speaking up behaviors and knowledge sharing.

Operating room (OR) “black boxes”;– which combine continuous monitoring of intraoperative data with video and audio recording of operative procedures – are increasingly used to improve clinical and team performance. This study surveyed OR professionals in Denmark and Canada about safety attitudes and privacy concerns regarding OR black box use. Participants were primarily concerned with safety climate and teamwork in the OR and use of OR black boxes can support learning and improvements in these areas. The North American cohort expressed more concerns about data safety.

Real-time use of artificial intelligence in the operating room allows surgeons to avoid or immediately address intraoperative adverse events. This review summarizes 13 articles published since 2010 that report on the use of artificial intelligence to predict intraoperative adverse events. Most studies used video and more than half were intended to detect bleeding.

Cognitive biases are a known source of misdiagnosis and post-operative complications. This review sought to identify the impact of cognitive biases on surgical performance and patient outcomes. Through thematic analysis of 39 studies, the authors identified 31 types of cognitive bias across six themes. Importantly, none of the included studies investigated the source of cognitive bias or mitigation strategies.

There is no consensus around how intraoperative adverse events should be measured and reported. This systematic review summarized the evidence regarding the measurement and reporting of these events and found that the frequency of events varied by detection method and noted a need to develop a framework to measure event severity and document corrective processes. A PSNet primer on measuring patient safety provides additional insight.  

Advances in technology enable real-time intraoperative data capture to prevent adverse events and improve patient safety and recovery. This commentary describes a surgical innovation that combined artificial intelligence, video technology, and clinical decision support and was designed to flag potential bleeding events in the surgical suite.

Teamwork training enhances health care team performance, especially in crisis situations. This systematic review identified 13 tools for assessing teamwork in high-stress settings, most of which were designed for the emergency department. A past PSNet perspective explored insights learned from experience with the AHRQ-supported teamwork training program, TeamSTEPPS.

Analysis of errors in aviation is facilitated by the cockpit "black box," which records flight data as well as communications between team members. This study reports on initial data from the OR Black Box, a novel monitoring technology that integrates continuous monitoring of intraoperative data with video and audio recording of operative procedures. In this initial study of elective laparoscopic procedures, auditory and cognitive distractions were common, and multiple safety events occurred during each procedure.

Although video and audio recordings of surgery may be useful in reviewing adverse events, previously used recording devices have only been able to capture a limited amount of data. This commentary describes the development of technology similar to the aviation black box that can collect a rich data set in the operating room for researchers to use to design targeted improvements.

… peer review of operating room videos. A recent AHRQ WebM&M interview with John Birkmeyer discussed his video study …

This systematic review identified several published methods for quantifying technical errors in laparoscopic surgery but concluded that none of the existing methods are optimal.

… journal of surgery. Journal canadien de chirurgie … Can J Surg … This review discusses how simulation can improve … to ensure their effectiveness. … Brindley PG, Jones DB, Grantcharov T, de Gara C. Can J Surg. 2012;55:S200-S206.   …