Patient safety research ready for take off

There is no equivalent to air traffic control in a hospital operating room, but the pressure to get patients through their care journey safely is just as high as in the airline industry. That's why North York General Hospital (NYGH) is the second hospital in Canada to join a world-leading research study led by St. Michael's Hospital to improve patient safety by using an OR Black Box®, which is similar to the technology used on airplanes.

Flight data recorders (black boxes) have helped the aviation industry become leaders in passenger safety because they provide a way for experts to understand and analyze the circumstances of a flight and make necessary changes. Given the prevalence of unintended patient harm in hospitals and the risks to patients — prolonged hospital stay, disability or death — researchers and clinicians have been looking at patient safety from multiple perspectives, including how other industries have improved their safety records.

Cancer Surgeon Dr. Usmaan Hameed performing surgery
North York General Hospital's first surgery recorded with the OR Black Box was performed by Dr. Usmaan Hameed in February 2018.

According to the Canadian Institute for Health Information and the Canadian Patient Safety Network, patients suffered potentially preventable harm in more than 138,000 hospitalizations in Canada, or about 1 in 18 hospitalizations (5.6%) between 2014 and 2015. 

The OR Black Box, spearheaded by Dr. Teodor Grantcharov, a Surgeon-Scientist at St. Michael's Hospital, is a multichannel data recorder used to capture the events and conditions in an operating room during surgical procedures. St. Michael's Hospital installed their OR Black Box three years ago and has since developed artificial intelligence algorithms that categorize intraoperative data into information that can be used for operating room quality improvement. For example, initial findings have shown that intraoperative distractions are associated with an increased risk of surgical adverse events.

“In health care we need to embrace the fact that when mistakes are made, they are rarely the result of any one person or single action — errors happen because there's a breakdown in process, not people,” says Dr. Lloyd Smith, Chief of Surgery at North York General Hospital. “There is no room for ‘blame and shame,' instead every situation is an opportunity to learn and everyone must feel empowered to speak up and act when it comes to patient safety.”

Steinberg Family Surgical Safety Program

As part of the newly created Steinberg Family Surgical Safety Program at North York General, three units of the OR Black Box will be used routinely. Long-time donors Charlotte and Lewis Steinberg, who provided funding for this program, have shown a tremendous amount of support for NYGH’s commitment to improving patient safety. 

Samuel Elfassy, Vice President, Safety at Air Canada and incoming Chair of the NYGH Board of Governors, played an instrumental role in facilitating the partnership with North York General, St. Michael's Hospital and Air Canada. This opportunity provides clinicians with a better understanding of airline safety and how it can be applied to the hospital sector. His insights and expertise have been vital to getting this important research off the ground. 

Dr. Usmaan Hameed, a General Surgeon at NYGH, welcomes the use of the OR Black Box and was the first to perform a recorded surgery at the hospital earlier this year. “The operating room is a dynamic environment and while there is a lot of standardization to the processes involved in all of our roles, there are many things we do that can be changed or improved,” says Dr. Hameed. “Looking at an operation from a 30,000 foot view is very different from the experience of performing a surgery in the moment and there is so much more we can learn by simply changing our perspective.” 

On the cusp of something big

The OR Black Box recordings made at North York General and St Michael's Hospital are used exclusively for research purposes and are only viewed by members of the health care and research teams. Recordings are destroyed after 30 days and patients must give consent in order to have their surgery recorded.

From a research perspective Patricia Trbovich, Badeau Family Research Chair in Patient Safety and Quality Improvement, is very excited about being a part of this innovative study. “I am very inspired by this ability to reframe how we study patient safety by not only looking at where things go wrong and how we can redesign our systems, but also by looking at all the ways in which our clinicians are resilient and how they do things right despite the fact they are presented with unexpected or unanticipated events,” says Patricia. “I think we are really on the cusp of something big in terms of how we study patient safety and I am thrilled that we are doing it here at North York General.”

This article first appeared in the April 2018 issue of The Pulse. 

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