JMIR Publications

ABSTRACT

Background:

A large proportion of surgical patient harm is preventable; yet, our ability to systematically learn from these incidents and improve clinical practice remains limited. The OR Black Box® was developed to address the need for comprehensive assessments of clinical performance in the operating room (OR). It captures synchronized audio, video, patient and environmental clinical data in real time, which are subsequently analyzed by a combination of expert raters and software-based algorithms. Despite its significant potential to facilitate research and practice improvement, there are many potential implementation challenges at the institutional, clinician, and patient level. This paper summarizes our approach to implementation of the OR Black Box® at a large academic Canadian centre.

Objective:

We aim to contribute to the development of evidence-based best practices for implementing innovative technology in the OR to improve patient safety, using the case of the OR Black Box®. Specifically, we outline the systematic approach to OR Black Box® implementation undertaken at our centre.

Methods:

Our implementation approach included: seeking support from hospital leadership; building frontline support and a team of champions among patients, nurses, anesthesiologists, and surgeons; accounting for stakeholder perceptions using theory-informed qualitative interviews; engaging patients; and documenting the implementation process, including barriers and facilitators, using the Consolidated Framework for Implementation Research.

Results:

During the 12-month implementation period, we conducted 23 stakeholder engagement activities with over 200 participants. We recruited 10 clinician champions representing nursing, anesthesia, and surgery. We formally interviewed 15 patients and 17 perioperative clinicians and identified key themes to include in an information campaign run as part of the implementation process. Two patient partners were engaged and advised on communications as well as grant and protocol development. Many anticipated and unanticipated challenges were encountered at all levels. Implementation was ultimately successful, with the OR Black Box® installed in August 2018, and data collection beginning shortly thereafter.

Conclusions:

The OR Black Box® is a leading-edge technological innovation for healthcare professionals and patients that has been implemented in selected centers internationally. Many centers around the world are considering adopting the OR Black Box® in the coming years and the process for implementation has not yet been formally documented until now. This paper represents the first step toward optimal implementation of audio-recording technologies like the OR Black Box® for research and quality improvement in the OR.