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develop skills, because surgeons won't take the risks needed to innovate tech-
niques out of fear of making mistakes.
During my surgical residency more than 15 years ago, I often felt great driv-
ing home after surgery, confident after another successful day in the OR. But
then I watched a video of myself in action, and it was embarrassing. I noticed
numerous things I needed to improve upon, and saw incredible amounts of
wasted effort and time. That's human nature. It's very difficult to be self-criti-
cal about your performance while you're in the middle of the action.
M
y research using "black box"
technology in the OR has
involved capturing data from
cases, analyzing it within 24 hours and
assessing patient conditions at 30 days post-
op to determine what impact surgical per-
formance had on outcomes.
The number of correctible errors we
noticed was eye-opening. For example, we saw
that a majority of errors taking place during
bypass surgery occurred during the same 2
steps of the procedure. Realizing that let us
design teachable steps for surgeons to practice
in order to master the technique in question.
Our research team also looked at not-so-
obvious sources of potential errors, such as
how hard a surgeon grips a bowel, which
might lead to slips and tears, and less tangible
factors, such as how surgeon frustration can
lead to communication breakdowns that
change the dynamics of the surgical team.
We're not only looking at errors, we're also
looking at how to improve time management
in the OR. For example, we can track how effi-
ciently a room was used throughout a day by
tracking how much time was allotted to turn-
ing it over between cases or was spent waiting
for instruments to return from central sterile.
— Teodor Grantcharov, MD, PhD
Identifying Room for Improvement
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