Project Summary It is estimated that fixing problems related to preventable errors costs the U.S. healthcare system $400 billion annually. In the field of surgery, the most basic element of quality care begins in the operating room (OR), and >50% of preventable errors that lead to patient harm happen there. The suboptimal performance of OR teams often lead to adverse events such as wrong site surgery, foreign object retention, and delays that greatly increase morbidity, mortality, and costs. Though using a surgical safety checklist can prevent errors and reduce patient harm, measurement of improve critical intraoperative processes has traditionally required putting observers inside the OR to record and analyze team performance. Since this process is labor-intensive and costly, it has been limited to a few large academic centers conducting funded research in quality improvement. The operating room Black Box® (ORBB) is an innovative technological and analytical platform, that synchronously captures the performance of the operating surgeon and the OR team while simultaneously recording patients’ vitals and postoperative outcomes. The ORBB uses machine learning to analyze performance and outcomes, making the program scalable and unlocking the potential for widespread monitoring and improvement of intraoperative team performance. However, large-scale adoption of the ORBB is limited by a lack of training programs that incorporate the data into an actionable form and by the absence of high-quality data on how to implement the ORBB in diverse hospitals. We hypothesize that addressing these barriers will lead to significant improvement in outcomes for surgical patients and propose three specific aims to test these hypotheses. In aim 1, a high fidelity immersive multi-player virtual simulator will be developed for training the OR teams in performing the surgical safety checklist. In aim 2, the validity and effectiveness of the virtual simulator in improving the quality of safety will be studied using the ORBB data. In aim 3, a study of ORBB implementation will be conducted to identify barriers and facilitators to adoption of the ORBB across the US healthcare system.

Narrative/Public Health Impact Errors occurring during surgery have a significant impact on patient outcomes, but it is hard to monitor and improve team performance in the operating room. The operating Black Box (ORBB) captures and analyzes data on intraoperative performance, providing a unique opportunity for improvement. This proposal seeks to develop strategies for effectively implementing such technology and creating high-fidelity simulation-based training to reduce errors and improve patient safety.