Anne van Dalen

Summary and General Discussion I 259 strong safety culture, all OR team members -irrespective of experience, hours and years working in the hospital- ought to be engaged and believe change in behaviour can actually improve patient safety. 50 51 To this end, implementation of the ORBBmay improve safety behaviour by facilitating team debriefing and consequently providing the team with the opportunity to discuss communication and teamwork issues affecting safety. During the team debriefings, differences in safety behaviour perceptions may be discussed, in a safe, blame-free, non-hierarchical environment. 51 52 Future studies with the ORBB or other medical data recorders -on larger scale and across different settings- are needed to evaluate whether improved safety behaviour actually leads to improved patient outcomes. Also, to strengthen the degree to which suitable inferences can safely be drawn about the impact of behavioural monitoring using medical data recorders on patient safety culture. Part III: Future use of the OR Black Box in the operating room The last few years have indeed seen a tremendous growth in the use of sensors, video and digital devices in the OR. 53 These applications generate large amounts of data in various formats, often referred to as ‘big data’. 54 A limitation in analyzing big data is that traditional data processing techniques are not able to handle these vast amounts of complex data. 55 The solution lies in artificial intelligence (AI) software. This term used to describe the study of algorithms that enables machines to reason and perform cognitive functions such as learning, problem solving, and decision-making. 56 57 As a result, AI has made its introduction into medicine and is expanding its footprint in surgical care. 53 This is of interest, as these high-risk environments are considered to be one of the most error-prone areas in the hospital, where outcome is highly dependent on use of modern technology generating multisource data. 20 58 The unique nature of surgical practice leaves healthcare professionals working in the OR therefore well-positioned to take the next step in the use of AI in the OR. 53 Using multiple data sources, including audio and video, AI could be a powerful tool for intra-operative decision support, used in warning systems to help the team predict and avoid adverse events that may lead to complications. 57