Although most algorithms function nearly flawlessly on their own, Peter Grantcharov explains that the OR black box still requires human intervention. For example, capturing audio through ceiling microphones to obtain a reliable transcript documenting completion of every element of the surgical safety checklist is challenging, with an estimated 15% error rate. Therefore, before finalizing the output from each procedure, a Toronto analyst manually verifies adherence to the questionnaire. Grantcharov states that the AI model has improved the process of confirming checklist compliance by 80% to 90% but emphasizes the ongoing efforts to enhance the models.
Janet Donovan, an OR nurse, shared that the OR black box installation can cost around $100,000, with annual analytics expenses of $25,000, according to an estimate provided to staff at Brigham and Women’s Faulkner Hospital in Massachusetts. While Grantcharov declined to comment on specific pricing, he mentioned that the costs are based on the product mix and the total number of rooms, with volume-based discounting included in the pricing models.
“Big brother is watching”
The Long Island Jewish Medical Center in New York, part of the Northwell Health system, was the first hospital to test OR black boxes in February 2019. The rollout faced challenges, not primarily due to the technology.
Northwell’s chair of urology, Louis Kavoussi, recalls incidents where cameras were tampered with in the colorectal room. In his own OR, staff members felt uneasy about being monitored while working. Kavoussi, now part of the scientific advisory board for Surgical Safety Technologies, acknowledges the initial discomfort among staff members.
Despite Grantcharov’s assurances that the system is not meant for punitive measures, some OR staff members remain apprehensive. The installation of black boxes at Faulkner Hospital in November 2023 caused distress within the department of surgery, with concerns about constant surveillance affecting job security and personal privacy.
Christopher Mantyh, vice chair of clinical operations at Duke University Hospital, notes that while identities are technically protected, there are still concerns about privacy. The recordings can reveal certain details, leading to a feeling of constant scrutiny among staff members.
Donovan, the Faulkner Hospital nurse, has raised concerns about staff members’ anonymity and the potential misuse of recordings. She and others have expressed objections to the black box system, highlighting worries about internal disciplinary actions or legal implications arising from the recordings.
