# Developing strategies for implementation and use of the Operating Room Black Box

> **NIH AHRQ R01** · UT SOUTHWESTERN MEDICAL CENTER · 2024 · $399,999

## Abstract

Project Summary
It is estimated that fixing problems related to preventable errors costs the U.S. healthcare system $400 billion
annually. In the field of surgery, the most basic element of quality care begins in the operating room (OR), and
>50% of preventable errors that lead to patient harm happen there. The suboptimal performance of OR teams
often lead to adverse events such as wrong site surgery, foreign object retention, and delays that greatly
increase morbidity, mortality, and costs. Though using a surgical safety checklist can prevent errors and reduce
patient harm, measurement of improve critical intraoperative processes has traditionally required putting
observers inside the OR to record and analyze team performance. Since this process is labor-intensive and
costly, it has been limited to a few large academic centers conducting funded research in quality improvement.
The operating room Black Box® (ORBB) is an innovative technological and analytical platform, that
synchronously captures the performance of the operating surgeon and the OR team while simultaneously
recording patients’ vitals and postoperative outcomes. The ORBB uses machine learning to analyze
performance and outcomes, making the program scalable and unlocking the potential for widespread
monitoring and improvement of intraoperative team performance. However, large-scale adoption of the ORBB
is limited by a lack of training programs that incorporate the data into an actionable form and by the absence of
high-quality data on how to implement the ORBB in diverse hospitals. We hypothesize that addressing these
barriers will lead to significant improvement in outcomes for surgical patients and propose three specific aims
to test these hypotheses. In aim 1, a high fidelity immersive multi-player virtual simulator will be developed for
training the OR teams in performing the surgical safety checklist.
In aim 2, the validity and effectiveness of the
virtual simulator in improving the quality of safety will be studied using the ORBB data.
In aim 3, a study of
ORBB implementation will be conducted to identify barriers and facilitators to adoption of the ORBB across the
US healthcare system.

## Key facts

- **NIH application ID:** 11050738
- **Project number:** 1R01HS029874-01A1
- **Recipient organization:** UT SOUTHWESTERN MEDICAL CENTER
- **Principal Investigator:** Courtney J Balentine
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2024
- **Award amount:** $399,999
- **Award type:** 1
- **Project period:** 2024-09-01 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11050738

## Citation

> US National Institutes of Health, RePORTER application 11050738, Developing strategies for implementation and use of the Operating Room Black Box (1R01HS029874-01A1). Retrieved via AI Analytics 2026-06-02 from https://api.ai-analytics.org/grant/nih/11050738. Licensed CC0.

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