title: Assessing team performance in the operating room: development and use of a "black-box" recorder and other tools for the intraoperative environment.
abstract: BACKGROUND
  The objective of this research was to develop a digital system to archive the complete operative environment along with the assessment tools for analysis of this data, allowing prospective studies of operative performance, intraoperative errors, team performance, and communication. Ability to study this environment will yield new insights, allowing design of systems to avoid preventable errors that contribute to perioperative complications.
  
  
  METHODS
  A multitrack, synchronized, digital audio-visual recording system (RATE tool) was developed to monitor intraoperative performance, including software to synchronize data and allow assignment of independent observational scores. Cases were scored for technical performance, participants' situational awareness (knowledge of critical information), and their comfort and satisfaction with the conduct of the procedure.
  
  
  RESULTS
  Laparoscopic cholecystectomy (n = 10) was studied. Technical performance of the RATE tool was excellent. The RATE tool allowed real time, multitrack data collection of all aspects of the operative environment, while permitting digital recording of the objective assessment data in a time synchronized and annotated fashion during the procedure. The mean technical performance score was 73% +/- 28% of maximum (perfect) performance. Situational awareness varied widely among team members, with the attending surgeon typically the only team member having comprehensive knowledge of critical case information.
  
  
  CONCLUSIONS
  The RATE tool allows prospective analysis of performance measures such as technical judgments, team performance, and communication patterns, offers the opportunity to conduct prospective intraoperative studies of human performance, and allows for postoperative discussion, review, and teaching. This study also suggests that gaps in situational awareness might be an underappreciated source of operative adverse events. Future uses of this system will aid teaching, failure or adverse event analysis, and intervention research.
authors.affiliation: Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22908-0709, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Guerlain
authors.forename: Reid B
authors.initials: RB
authors.lastname: Adams
authors.forename: F Beth
authors.initials: FB
authors.lastname: Turrentine
authors.forename: Thomas
authors.initials: T
authors.lastname: Shin
authors.forename: Hui
authors.initials: H
authors.lastname: Guo
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Collins
authors.forename: J Forrest
authors.initials: JF
authors.lastname: Calland
mesh_terms: D017081:Cholecystectomy, Laparoscopic; D002983:Clinical Competence; D003142:Communication; D006801:Humans; D007400:Interprofessional Relations; D009873:Operating Rooms; D010348:Patient Care Team; D017064:Process Assessment, Health Care; D012985:Software Design; D013647:Task Performance and Analysis; D014584:User-Computer Interface; D014741:Video Recording