The OR Black Box (ORBB) is a technology system that captures audio-visual, environmental, and patient physiologic information in the operating room. Its purpose is to provide insight into how an operating room functions. This information can be used to improve efficiency, quality, safety, and culture.
Quality and Safety
At UT Southwestern Medical Center, we’re committed to providing our patients with high-quality health care in a medically safe environment at every step of their evaluation and treatment.
It’s a commitment that we back with action. In 2010, UT Southwestern launched a Quality Improvement Program to oversee clinical quality and patient safety throughout the Medical Center. Since that time, we have implemented many improvement strategies aimed at providing the best possible care for patients and their loved ones.
When it comes to our patients’ health, perfection is our goal and our unrelenting mission.
Why Tracking Our Performance Matters
We think it’s important to measure quality and safety information and make it readily available for two primary reasons:
- It helps us continually improve every aspect of patient care.
- It assists our patients with making informed decisions regarding their medical care.
To better serve our patients, we take into account many different types of measures for quality and safety and compare ourselves at the national and state level. These measures show how UT Southwestern has been doing at providing the right care for certain common conditions and keeping patients safe.
Preventive care includes making sure all patients are evaluated (and treated) for conditions including the flu and hospital-acquired blood clots. Preventive care should happen when patients are in the hospital, in order to provide the best outcomes.
The influenza vaccine is the most effective method for preventing the flu and its complications. This core measure of patient care shows the percentage of patients who were assessed for the flu vaccine and then given it when it was recommended.
- How UT Southwestern performs: UT Southwestern Medical Center’s influenza vaccination rate is close to 100%. This outperforms the national average and reflects our status as a leader in patient care. For these scores, a higher number is better.
Academic medical centers like UT Southwestern tend to take care of very sick patients and handle very complicated cases. As a result, we track 30-day death rates, which tell us how many patients die relative to what is expected, given a variety of complicating characteristics. These characteristics include age, chronic conditions such as diabetes or heart failure, and whether the patient was transferred from another hospital or admitted as an emergency.
The scores below show the percent of patients who died, for any reason, within 30 days of going into the hospital.
- How UT Southwestern performs: UT Southwestern Medical Center’s heart failure patients experience a lower death rate than the national average. We meet the national average for death rates for chronic obstructive pulmonary disease (COPD), heart attack, and coronary artery bypass surgery (CABG) patients. For these scores, a lower number is better. “No Different than the National Rate” means that statistically our hospitals perform the same as the national average. Pneumonia wasn't reported during this timeframe due to COVID-19.
The chart below shows the number of patients with heart failure and reduced ejection fraction followed at UT Southwestern Medical Center and the number and rates of the 4 pillars of guideline directed medical therapy (GDMT) prescribed for these patients over a two-year period for both UT Southwestern overall and for patients followed specifically in the Heart Failure clinic.
The medications are ACE (angiotensin converting enzyme inhibitor)/ARB (angiotensin receptor blocker)/ARNI (angiotensin receptor/neprilysin inhibitor); BB (β-blockers); MRA (mineralocorticoid receptor antagonist); SGLT2i (sodium/glucose cotransporter-2 inhibitor).
We encourage our patients and families to share their care and treatment experiences. One of the ways we learn about our patients’ feedback is through a survey called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).
- How UT Southwestern performs: UT Southwestern performs significantly higher than the national average for both overall rating as well as the percentage of patients who would definitely recommend the hospital. We are proud of our commitment to patient satisfaction and continually strive to improve our patients’ hospital experience.
The OR Black Box
The purpose of the OR Black Box program is the continuous improvement of surgical performance and, as a result, patients’ health care experience, while simultaneously helping to control the total cost of care and improve value.
The OR Black Box captures audio and visual information from the operating room, as well as information from various patient monitors and medical devices, such as the anesthesia machine and robotic surgical devices, and coordinates the information for a quality review to show health care workers opportunities for improvement.
Currently we are using the OR Black Box technology to capture data on any surgeries that occur in the ORs in which the equipment is installed, with a focus primarily on laparoscopic and robotic surgeries typically performed in thoracic surgery, otolaryngology (head and neck tumors) surgery, urologic surgery, and oncology surgery. Audiovisual data will be captured during a procedure, along with patient physiologic data, administration of anesthesia, and other information, which are then analyzed by an independent reviewer to identify opportunities for improvement.
The OR Black Box reviews are designed to allow greater transparency to OR practices and to identify opportunities for improving processes, skill sets, timing, and other efficiency indicators to improve patient safety, quality, and outcomes. Surgeons, for example, can train for greater precision, nurses can identify more efficient ways to ensure preparations are ready and transitions are smooth, and surgical teams can work to identify better methods of communication for improved teamwork.
Although you are recorded as part of the surgery, your identity remains unknown to the reviewer, and all audio and video is then subsequently deidentified by the third-party reviewer. The information UT Southwestern receives back from the reviewer is fully deidentified and is covered by privacy protection agreements that are in place. All data are passed through encrypted and secured data transfer protocols. The recordings are designed for quality review purposes and are only available for that process. They are not part of your medical record, and other entities such as insurance companies do not have access to the data.
There is no additional charge and no impact on the cost of your procedure.
Consent is obtained as part of the surgical consent, which is the agreement to permit the surgical procedure to take place. Your surgeon can answer any additional questions about the Black Box technology and subsequent data reviews.
To learn more about quality and safety measures, we encourage you to check out the following resources:
- Medicare’s Hospital Compare: A tool provided by the government to compare how well the hospitals in a particular area care for all their adult patients with certain medical conditions.
- U.S. News & World Report: Compare hospital performance in adult and pediatric clinical specialties, procedures, and conditions. Scores are based on several factors, including survival, patient safety, and nurse staffing.
- The Joint Commission: This independent group accredits and certifies health care organizations and programs and includes information on quality and safety.
- Healthgrades: This website provides comprehensive information – including patient reviews – about physicians and hospitals.
- Leapfrog: This website offers detailed ratings and reports showing how hospitals perform.