Operating room black box: Scrutinizer of theatre practices

Adverse surgical events are a major cause of morbidity, mortality, and disability worldwide. The cause of many such events can be attributed to interruptions in the operating room (OR), multitasking by surgeons, etc. The objective of this study was to observe the types and frequency of intraoperative workflow interruptions in our ORs. This cross-sectional study was conducted from March to April of 2023. An observational approach using an audio-video recording device was employed to record OR flow disruptions. One elective OR and one emergency OR under the Department of General Surgery were selected for the study. All open and laparoscopic surgeries conducted in the selected ORs were included. An Internet Protocol camera was installed in the selected ORs with a view of the entire room, including the anesthesia station. Audio-video recording was started after the first incision and stopped after closure of the surgical site. Of the 51 cases that were studied, 45 (88.2%) were elective, and 18 (35.3%) were laparoscopic cases. They could be classified into 8 types of open procedures and 4 types of laparoscopic procedures. The mean maximum head count inside the OR was 15.5 ± 3.6 and doors opened on average of 15.8 ± 6.0 times during a procedure. Other interruptions were surgeons attending phone calls (24, 47.1%), leaving the sterile area (21, 41.2%), technical disturbances (32, 62.7%), anesthetic interruptions (18, 35.3%), and faulty instruments (29, 56.9%). Elective procedures had a significantly higher average number of interruptions per operating hour than emergency procedures (17.5 ± 8.6 vs. 7.1 ± 2.9, p<0.01). Preventable factors such as faulty instruments, anesthetic interruption, and attending phone calls by the surgeon are commonly observed in ORs. They need to be addressed by timely surgical audits or the adoption of continued surveillance methods that can help take measures to minimize their occurrence.