Tuesday, October 8, 2013

Can A "Black Box" In The Operating Room Reduce Surgical Malpractice?

Yes, according to a Canadian surgeon who has developed aviation "black box" type technology for use in the operating room.

Most everyone is familiar with the "black box" that is retrieved from the remnants of the plane after a crash to study data at the time of the crash with an eye towards getting to the root cause and preventing future crashes. According to inventor and surgeon Teodor Grantcharov, MD,  the "OR black box works in similar fashion: it records video, audio, vital signs, the data from the anesthesia monitor, and lots of other important data that can be studied.

His purpose in developing this breakthrough software? Enhancing patient safety. The idea is that surgical mistakes can be studied in real time and used as a teaching tool to reduce or eliminate adverse errors and patient harms.

But how will the medical profession react to this newfound technology? Will it be welcomed with open arms, or will they fight it tooth and nail because it will be objective evidence of what happened in the operating room, making it less likely or impossible to "sanitize" what happened if a true medical mistake occurs?

My guess is that the initial reaction of surgeons and hospitals will be: "forget it!" They may well argue that black box technology will increase the chances of a medical malpractice lawsuit because patients (and their greedy lawyers) will try to get their hands on the data if a patient suspects that medical negligence occurred.

But I believe it may well have the opposite effect. Technology like this will ultimately serve a laudable goal of reducing the true incidence of operating room malpractice, which will in turn reduce even further the number of malpractice lawsuits. And a reduction of both is a good thing.

As it stands right now, the surgeon's dictated operative report is often the official paper version of what happened in the operating room, whether it consists of the truth, the partial truth, or a whitewashed version of the truth. Frequently, it is not representative of what actually transpired, and in cases where malpractice is suspected, the OR report can sometimes be unraveled in the face of later, objective data that tends to cast doubt on the surgeon's description of events.

And, sometimes, it stands as the truth even if it is a lie, because of the attorney's inability to prove that it was shaded or sanitized.

Black box technology is a potential game changer because of its objectivity. We hear all the time that patient safety is goal number one of any medical institution. As the technology progresses, it will be interesting to monitor the medical profession's position on its use, and how serious it is about patient safety.

After all, almost 400,000 people a year needlessly die in hospitals every year due to preventable medical mistakes. By comparison, less than 100 passengers on average die every year in the U.S. due to plane crashes. And when the plane crashes, we demand an immediate investigation and retrieve the black box, since a single plane crashing is unacceptable in our society.

Simple math--and protection of life--seem to make this decision a no brainer with respect to hospitals embracing the black box.



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