A Black Box for the Operating Room

Susan Shepard | Jun 05, 2023

Most of us are familiar with the black boxes used in the transportation industry that help ensure the safety, efficiency, and performance of their products and users. Now, a similar technology is not only helping the operating room (OR) to become a safer and more efficient place, but it can also help to quantify the value of new technologies.

"Traditionally, the operating room has been one of the most secretive environments in our society," said Teodor Grantcharov, the founder of Surgical Safety Technologies (SST), in an interview with MD+DI. But with SST's OR Black Box technology, those secrets can now be brought to light.

SST's OR Black Box has two functions, Grantcharov explained. It not only evaluates the performance of a surgeon, but also evaluates the efficacy of certain medical devices.

"It sensorizes the [OR]," he said. "It consists of a set of sensors that link to software that we have developed that captures data from various sources in the [OR] and turns it into information that hospitals and doctors can use to improve safety, to improve education, to improve efficiency, and improve compliance to standard operating procedures."

Evaluating the performance of the surgeon is based on a video of the procedure. "It's a set of AI-based algorithms that monitor how coordinated the movement of the surgeon are, how many movements, how long it takes them to execute certain steps of the procedure," Grantcharov explained, noting that other parameters include whether the patient is bleeding or if there is injury to any vital structures while the surgeon is performing the procedure.

The second function of the OR Black Box is to track adverse events, or near misses, Grantcharov said. "For example, if we see a cluster of staplers misfiring or any type of device that malfunctions, we can see the pattern of malfunctions a long time before it has resulted in patient injury or harm," he said. "We can work with the device manufacturers to give them the feedback and say ‘hey, there is something here. There is a signal, let's investigate it together.’"

The black box generates hundreds of thousands of parameters, Grantcharov said, which can be overwhelming for a human to review. Instead, AI-based algorithms process these performance metrics and provides hospitals and device manufacturers with information points. "We process data to a point… that doctors and hospitals can consume and act upon," he said.

Since the launch of the OR Black Box in 2020, users have benefited from improvements in hospital efficiency. "Some of them have been very dramatic," he said. "We have shown that the data could be used to improve efficiency and hospitals could save hundreds of thousands of dollars by better scheduling, preoperative services, and reducing turnover time."

He also mentioned that a recent trial showed there is a significant improvement in clinical outcomes for the patients when the OR Black Box in used during their procedures.

Grantcharov sees a lot of collaborative projects in SST's future. "Not only with hospitals and device manufacturers where we can collaboratively work toward the common goal to make all new devices and equipment… much safer and more efficient," he said. "But also answer the very important question, which is ‘what about value?’ It looks better and it feels better, but does it really justify the increase cost in a time where hospitals are struggling to just survive financially? I think we'll see more and more questions and scrutiny whenever we bring new technology on the return on that investment. I think the black box can provide a lot of important information."

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