22 Pioneering surgical patient safety with artificial intelligence (AI)

<h3>Background</h3> Team performance &amp; safety culture in the operating room are imperative for patient safety. The use of audio/visual data capture &amp; analysis in healthcare has demonstrated success in trauma care for education, training &amp; improving processes. There is a lack of objective evaluation of team performance &amp; safety measures in the operating room (OR). <h3>Objectives</h3> With support from CRICO, the malpractice insurer for the Harvard Medical Institutions and hospital leadership support, Brigham and Women’s Faulkner Hospital (BWFH) launched a pilot utilizing AI driven audio/visual technology (Operating Room Black Box, ORBB). In 2022, BWFH identified this as an institutional priority. <h3>Methods</h3> The ORBB records surgical procedures, creating thousands of data points, and uses AI algorithms to measure safety checklist compliance, track OR efficiency, and provide de-identified video to enhance grand rounds/Morbidity &amp; Mortality (M&amp;M) conferences. Development and implementation for this pilot took a structured approach. The groundwork was multifaceted involving critical input from Nursing, Anesthesia, Surgery, Patients, Legal &amp; Compliance. <h3>Results</h3> The ORBB was installed in 2 of 16 OR’s. Implementation of the ORBB took longer than expected. A critical roadblock was the significant socialization efforts required to gain buy-in from all departments. With analysis of over 1000 surgical cases, initial data suggest strong compliance with the Safe Surgery Checklist (SSC). Debriefs are not performed as well as other portions of the SSC. <h3>Conclusions and Implications</h3> The ORBB has the potential to improve patient safety and reduce surgical errors in the OR. By providing objective performance of the SSC, it highlights areas where checklist performance can be improved which impacts patient safety. Implementation of the ORBB can be arduous due to fears surrounding audio/visual recording, however developing an explicit plan for socialization and identifying champions from each department are key strategies to overcome barriers.