Video Cameras in the OR May be Inevitable
In their study Greenberg and colleagues used all that equipment and received surgeon and patient consent to record 10 complex procedures—nearly 44 hours of video—at Brigham and Women's Hospital. They then got experts to review what they saw, down to every delay, hurried exchange, miscommunication, and misunderstanding. These were tough cases, with expected complication rates of greater than 20%.
Among those 10 cases, recorded from room set-up through patient exit, experts found 33 "deviations," which included 10 delays in the procedure of at least two minutes, 17 safety compromises that put the patients at risk, and six instances in which a deviation included both a safety compromise and a delay.
In one case, for example, lack of communication resulted in misinformation between the anesthesiologist and surgeon about whether a patient, who developed cardiac ischemia, was "bleeding."
Lack of coordination contributed to deviations as well. "Attending surgeons were frequently absent at the beginning of their cases, causing delays ranging from 8 to 28 minutes. Even teams familiar enough with their attendings' preferences to begin without them ultimately reached a point at which progress halted, and they were forced to idly wait," she and colleagues wrote in their report.
Even though the surgeons themselves "had the impression that their cases went quite smoothly, Greenberg says, they ultimately "identified points in the case where it was less efficient than it could have been, and they were spending time figuring out how to move the case forward in a way that could be improved in future cases."
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