Introduction of a surgical Black Box system in a hybrid angiosuite: Challenges and opportunities

•The OR Black Box® is a comprehensive data capture platform for quality improvement.•This system has been installed in a hybrid angiosuite for the first time worldwide.•Captured data facilitates evaluation of (non-)technical skills and radiation safety.•Detailed analysis of (near-miss) errors and di...

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Bibliographic Details
Published in:Physica medica 2020-08, Vol.76, p.77-84
Main Authors: Doyen, Bart, Gordon, Lauren, Soenens, Gilles, Bacher, Klaus, Vlerick, Peter, Vermassen, Frank, Grantcharov, Teodor, Van Herzeele, Isabelle
Format: Article
Language:English
Subjects:
Endovascular surgery
Patient safety
Quality improvement
Radiation safety
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Summary:•The OR Black Box® is a comprehensive data capture platform for quality improvement.•This system has been installed in a hybrid angiosuite for the first time worldwide.•Captured data facilitates evaluation of (non-)technical skills and radiation safety.•Detailed analysis of (near-miss) errors and distractions may augment team feedback.•Black box technology may improve team and patient safety in endovascular surgery. In laparoscopy, the Operating Room Black Box® (ORBB) provides insights into operative performance to improve patient safety. This technology may also enhance endovascular surgical practice; however, the use of a C-arm and X-rays pose important challenges, hindering transferability to an endovascular context. We describe the first implementation of ORBB technology in a hybrid angiosuite and illustrate its value in evaluating surgeons’ radiation safety, technical and non-technical performance. Team members (surgeons, nurses, anaesthesiologists) and stakeholders were informed during several information sessions. Together with teams from Surgical Safety Technologies (Toronto, Canada), an implementation plan was developed, and video-evaluation frameworks were chosen. Radiation safety was assessed using dose measurements and video-evaluation of safety-related behaviours. Technical performance was assessed using ‘global’ (GRS) and ‘procedure-specific’ (PRS) rating scales and the ‘EndoVascular Aortic Repair Assessment of Technical Expertise’ (EVARATE) framework. Surgeons’ non-technical skills were assessed with the NOTSS framework. The system captures Audio-visual data from four ceiling-mounted cameras, three ceiling-array microphones, the fluoroscopy screen and anaesthesia monitor. After patient and team consent, an elective endovascular aneurysm repair was successfully analysed. Dose-Area-Product and Air Kerma were 71094 mGy.cm2 and 270 mGy, respectively. Behavioural analysis revealed deficiencies in stepping back and radiation safety communication. Technical skill assessment was feasible: GRS: 29/40; ‘PRS’: 27/35; EVARATE: 29/35. Non-technical analysis highlighted surgeons’ leadership qualities. An innovative data capture platform has been successfully installed to evaluate overall performance during endovascular procedures. This technology may facilitate identification of (radiation) safety-related errors and instigate educational interventions based on real-world issues.
ISSN:1120-1797
1724-191X
DOI:10.1016/j.ejmp.2020.06.013