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.

Leveraging lessons learned in aviation, patient safety researchers have begun exploring the use of medical data recorders (i.e., “black boxes”) to identify errors and threats to patient safety. This cross-sectional study found that a medical data recorder identified an average of 53 safety threats or resilience support events among 35 standard laparoscopic procedures. These events primarily involved communication failures, poor teamwork, and situational awareness failures.

Despite widespread use of surgical safety checklists (SSC), its success in improving patient outcomes remains inconsistent, potentially due to variations in implementation and completion methods. This systematic review sought to identify how many studies describe the ways in which the SSC was implemented and completed, and the impact on provider outcomes, patient outcomes, and moderating factors. A clearer positive relationship was seen for provider outcomes (e.g., communication) than for patient outcomes (e.g., mortality).

… increased patient safety risks, and poor team morale.   … Etherington C, Kitto S, Burns JK, et al. How gender shapes …

Resilience is the process of identifying and overcoming unexpected adverse events. By reviewing video, audio, and patient physiologic data recorded during 24 laparoscopic surgeries, researchers were able to identify safety threats and resilience supports used to overcome them. Of the six category codes, (person, task, tools and technology, physical environment, organization, and external environment) most safety threats and supports were in the person category.

… or errors in disposition. … Nikouline A, Quirion A, Jung JJ, et al. Errors in adult trauma resuscitation: a …

… Br J Anaesth … Handoffs between providers can introduce patient … increases the risk of an adverse event by 40%. … Boet S, Djokhdem H, Leir SA, et al. Association of … and mortality: a systematic review and meta-analysis. Br J Anaesth. 2020;125(4):605-613. Epub 2020/07/20. …

This qualitative study sought to identify barriers and enablers influencing stakeholder support of the Operating Room (OR) Black Box, an audio-video recording device similar to that used on airplanes. Stakeholders were mostly supportive of the OR Black Box, but several potential barriers were identified, such as time pressures in the OR and perceptions that the Black Box may negatively impact clinical performance. Authors concluded that the OR Black Box must be positioned as a patient safety initiative to improve practice.

Interdisciplinary teamwork is critically important in labor and delivery for anesthesiologists, obstetricians, midwives, and nurses to provide optimal care. This systematic review of interventions designed to improve teamwork found that simulation-based teamwork interventions can improve team performance and morbidity in the labor and delivery setting. 

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.

… Journal of interprofessional care … J Interprof Care … This systematic review found that …

This series of blinded video reviews of laparoscopic surgeries identified the technical surgical errors that led to complications. This study adds to the emerging evidence supporting peer review of operating room videos. A recent AHRQ WebM&M interview with John Birkmeyer discussed his video study that found a link between practicing surgeons' directly observed technical skills and surgical safety outcomes.

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