Introduction of a surgical Black Box system in a hybrid angiosuite: Challenges and opportunities

Bart Doyen; Lauren Gordon; Gilles Soenens; Klaus Bacher; Peter Vlerick; Frank Vermassen; Teodor Grantcharov; Isabelle Van Herzeele

doi:10.1016/j.ejmp.2020.06.013

Introduction of a surgical Black Box system in a hybrid angiosuite: Challenges and opportunities

Phys Med. 2020 Aug:76:77-84. doi: 10.1016/j.ejmp.2020.06.013. Epub 2020 Jun 29.

Authors

Bart Doyen¹, Lauren Gordon², Gilles Soenens³, Klaus Bacher⁴, Peter Vlerick⁵, Frank Vermassen⁶, Teodor Grantcharov⁷, Isabelle Van Herzeele⁸

Affiliations

¹ Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium. Electronic address: Bart.Doyen@ugent.be.
² Department of Surgery, University of Toronto, Toronto, ON, Canada. Electronic address: GordonLau@smh.ca.
³ Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium. Electronic address: Gilles.Soenens@ugent.be.
⁴ Department of Human Structure and Repair, Ghent University, Ghent, Belgium. Electronic address: Klaus.Bacher@Ugent.be.
⁵ Department of Work, Organisation and Society, Ghent University, Ghent, Belgium. Electronic address: Peter.Vlerick@ugent.be.
⁶ Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium. Electronic address: Frank.Vermassen@ugent.be.
⁷ Department of Surgery, University of Toronto, Toronto, ON, Canada. Electronic address: GrantcharovT@smh.ca.
⁸ Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium. Electronic address: Isabelle.Vanherzeele@ugent.be.

PMID: 32615511
DOI: 10.1016/j.ejmp.2020.06.013

Abstract

Purpose: In laparoscopy, the Operating Room Black Box® (ORBB) provides insights into operative performance to improve patient safety. This technology may also enhance endovascular surgical practice; however, the use of a C-arm and X-rays pose important challenges, hindering transferability to an endovascular context. We describe the first implementation of ORBB technology in a hybrid angiosuite and illustrate its value in evaluating surgeons' radiation safety, technical and non-technical performance.

Methods: Team members (surgeons, nurses, anaesthesiologists) and stakeholders were informed during several information sessions. Together with teams from Surgical Safety Technologies (Toronto, Canada), an implementation plan was developed, and video-evaluation frameworks were chosen. Radiation safety was assessed using dose measurements and video-evaluation of safety-related behaviours. Technical performance was assessed using 'global' (GRS) and 'procedure-specific' (PRS) rating scales and the 'EndoVascular Aortic Repair Assessment of Technical Expertise' (EVARATE) framework. Surgeons' non-technical skills were assessed with the NOTSS framework.

Results: The system captures Audio-visual data from four ceiling-mounted cameras, three ceiling-array microphones, the fluoroscopy screen and anaesthesia monitor. After patient and team consent, an elective endovascular aneurysm repair was successfully analysed. Dose-Area-Product and Air Kerma were 71094 mGy.cm² and 270 mGy, respectively. Behavioural analysis revealed deficiencies in stepping back and radiation safety communication. Technical skill assessment was feasible: GRS: 29/40; 'PRS': 27/35; EVARATE: 29/35. Non-technical analysis highlighted surgeons' leadership qualities.

Conclusion: An innovative data capture platform has been successfully installed to evaluate overall performance during endovascular procedures. This technology may facilitate identification of (radiation) safety-related errors and instigate educational interventions based on real-world issues.

Keywords: Endovascular surgery; Patient safety; Quality improvement; Radiation safety.

MeSH terms

Aortic Aneurysm, Abdominal*
Blood Vessel Prosthesis Implantation*
Canada
Endovascular Procedures*
Humans
Operating Rooms