Thinking outside the box to improve surgical safety for patients

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Thinking outside the box to improve surgical safety for patients

Toronto, March 5, 2020

By Ana Gajic

Dr. Teodor Grantcharov

How does an operating room’s team culture impact a patient’s surgical outcomes? What about the number of times the OR door opens during a procedure? Or the types of distractions the team experiences while performing surgery?

The International Centre for Surgical Safety – a research and innovation centre within the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto – aims to answer these types of questions to enhance safety for patients around the world. It breaks down barriers within the OR to understand how complex factors can impact patients and team members.

“The operating room is one of the most secretive environments in our society,” says Dr. Teodor Grantcharov, surgeon and director of the ICSS. “Throughout the years we’ve created false expectations of perfection in the OR. This is the biggest limitation for learning. By studying what we do right and wrong, we can see opportunities to improve.”

With innovative technology that extracts the digital footprint of every surgical procedure through audio-visual data, physiological data and data from devices and sensors, the ICSS team uses human and artificial intelligence to analyze these metrics and make suggestions for improvements.

Though everything is captured, no information is used punitively. All data goes towards understanding how a surgery can be enhanced to create an optimal environment for teams to work in and for patients to thrive.

“Traditionally, we research the patient experience before surgery and after,” said Dr. Vanessa Palter, a cancer surgeon and scientist at the ICSS. “For any surgical patient, what happens in the operating room is probably the most important part of their experience but it has been significantly under investigated.”

The centre started with a vision to address this gap. Dr. Grantcharov’s first lab at St. Michael’s focused on surgical simulation and education. From there, he and his team developed the now commercialized OR Black Box concept, which is the technology that monitors operating rooms.

The team behind the OR Black Box has spun off this technology and others into a company called Surgical Safety Technologies and the St. Michael’s Hospital Foundation secured funds to transition Dr. Grantcharov’s research lab into the International Centre for Surgical Safety.

The technology of the OR Black Box, which captures everything that happens in the OR, has spread to other hospitals in Canada, the United States and Western Europe and TIME Magazine featured this innovation as one of the best inventions in 2019. At St. Michael’s, 10 ORs will be equipped with the Black Box. This all means more data for the team to analyze in their research.

“The collaboration with other centres is key to the success of the ICSS,” said Amy Dionne, managing director of the centre. “Not only do we have a team that’s diverse in skill set – spanning from engineers to clinicians to computer scientists – but our partners’ diverse environments help us ensure our evidence is grounded in reality.”

In a recent example, the research team published a study in Surgical Endoscopy that looked at distractions in the OR. They found that irrelevant conversations in the OR were a modifiable factor that was associated with the surgeon feeling distracted. This, Dr. Grantcharov said, is one example of a small but important shift to improve surgical safety patients.

As the key stakeholders, patients have been great supporters of this work. In fact, many are surprised that the idea of observing ORs to improve on surgical processes is novel.

“Patients feel like we offer them the characteristics of a health care professional they want to see,” Dr. Grantcharov said.

“Teams that are open, transparent, accountable and good communicators are teams that create the best care experiences for our patients.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit

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