Black Boxes in the Operating Room: Improving Quality of Care and Patient Safety

What’s covered in this post?

  • Black boxes record video, audio, and data from multiple sources in the operating room (OR), such as cameras, microphones, patient monitoring equipment, and medical devices.
  • By offering transparency on the multiple simultaneous processes in the OR, black box data can be used to improve safety and efficiency, train staff, and onboard new nurses.
  • The data can be used for retrospective analysis of specific events or aggregate analysis to detect patterns and variations in practice over time.
  • Black box data has been used to improve and standardize OR processes such as handling tissue samples, handoff communication during shift changes, and pre-surgical patient positioning.
  • The data is de-identified and is normally deleted within 30 days.
  • Finding what went right and learning from it is the goal, not pointing fingers.

Figures in the OR as recorded and de-identified by an OR Black Box. Image courtesy Surgical Safety Technologies.

Rebecca McKenzie, DNP, MBA, MSN, RN, assistant vice president of perioperative services at Duke University Hospital, recently spoke with AJN about her hospital’s use of black boxes in operating rooms (ORs) to standardize key processes to improve safety and efficiency, […]

Pediatric Mental Health Tops ECRI’s 2023 Top 10 Patient Safety Concerns

Photo by Eric Ward on Unsplash

Each year, the ECRI Institute creates a list of top 10 patient safety concerns along with actionable recommendations for institutions to reduce these risks.

Some years, the list includes repeat offenders such as medication errors and concerns surrounding staffing. In the past few years, the list has reflected the reality of living during a global pandemic, with 2022’s top 10 concerns including clinician’s mental health, supply chain disruptions, and vaccine coverage gaps. This year’s list moves away from the pandemic somewhat, but still includes some fallout from COVID-19, with the number one concern reflecting a crisis among our youth: pediatric mental health.

According to the report:

“Concern for pediatric mental health was already high during the 2010s due to the growing use of social media, limited access to pediatric behavioral health providers, drug and alcohol use, gun violence, and socioeconomic impact, among other stressors. However, pediatric mental health issues have been exacerbated by the COVID-19 pandemic, with a 29% increase in children age 3 to 17 experiencing anxiety and a 27% increase in depression in 2020 compared with 2016.”

The report lists some recommendations to confront this issue, including securing leadership support and resources to evaluate the organization’s pediatric […]

Every Patient Needs an IV, or Do They?

(This post is by an author of AJN‘s January CE feature, “Evidence-Based Practice for Peripheral Intravenous Catheter Management.”)

Questioning the status quo.

As a former critical care nurse and now a vascular access nurse researcher, I’ve had the good fortune to travel widely and work with nurses from around the globe on multiple projects. As a researcher, part of my role is to question clinical practices we often take for granted and to ask, “Is this the best way? Could there be a better way?” Identifying practice that may not always be evidence-based is how research often begins.

Prior to the Covid-19 pandemic, I undertook a two-month fellowship in the US and visited several hospitals where, time and again, I noticed the majority of hospital patients had a peripheral intravenous catheter (PIVC) in place, but many were not in use. When I asked the nursing and medical staff why patients had a PIVC that was not in use, I was repeatedly told, “Every patient needs an IV, just in case.” When I pointed out that some patients had two or three PIVCs not in use, or a central venous access device as well, it became obvious that this is a common problem.

An ‘idle’ catheter is a PIVC that has not […]

2023-01-11T11:41:34-05:00January 11th, 2023|Nursing, patient safety|0 Comments

ER Nurse Who Called 911 for Backup: ‘What Are We Afraid Of?’

Making the call.

As I got home this morning after a hectic 12-hour shift as charge RN in a 50-bed ER, I sat in my silent car for a moment to ponder how much has changed in the last three weeks.

Three weeks ago, overwhelmed by walk-in patients and ambulance traffic and severely short-staffed, I called the emergency services non-emergent line and asked for help in our crowded lobby. I wasn’t thinking about the repercussions, about the uproar or the giant target I sometimes feel I’ve installed on my back with my outspokenness. I was thinking about my coworkers, spread too thin, exhausted and afraid for their licenses, and the patients that I knew had been sitting in the lobby for hours, sick and in pain and mostly unmonitored. I had no idea of the attention that call would receive.

Did speaking out change anything?

Someone recently asked, “What changes have you seen in the month since you made that call?”

For myself, I’ve been learning to navigate in a more public arena, […]

Staffing Tops ECRI 2022 Top 10 Patient Safety Concerns List for First Time

Staffing: the problem has ‘grown exponentially.’

Each year, ECRI Institute creates a list of top 10 patient safety concerns in order “to support organizations in their efforts to proactively identify and respond to threats to patient safety.” Over the years, some repeat offenders have made the cut, for example managing behavioral health, patient falls, and issues related to infection control.

Some of these concerns again appear on the 2022 top 10 patient safety concerns list, but the list also has some notable first-time offenders—a fact that reflects the conditions in which we’ve been living over the past two years during this global pandemic: These include COVID-19’s effect on clinicians’ mental health, vaccine coverage gaps, and supply chain disruptions, to name a few.

However, the number one concern this year is one that has been a central and unrelenting issue for nurses, even before the pandemic—staffing shortages.

According to the ECRI:

“The number one topic on this year’s list has been steadily growing throughout the COVID-19 pandemic and impacts patients and staff on all levels: staffing shortages…Prior to 2021, there was a growing shortage of both clinical and non-clinical staff, but the problem has grown exponentially. In early January 2022, it was estimated that 24% of US hospitals were […]

2022-03-24T10:04:38-04:00March 24th, 2022|Nursing|0 Comments
Go to Top