From box ticking to the black box: the evolution of operating room safety

Efforts to improve the safety of patients in the operating room have focused on mitigating harm through the standardization of system, team, and human level factors. This article highlights existing and future methods for enhancing safety in the perioperative setting, and the theory and principles that underpin them.

Evidence surrounding the development and implementation of select surgical safety interventions is discussed.

Work in human factors and engineering that has inspired safety interventions such as the WHO Safety Checklist, and more recently operating room recorders, represents a movement away from traditional, retrospective or reactive methods of studying surgical safety, to prospective and proactive ones.

Future work will examine the effectiveness of these interventions for improving patient outcomes and minimizing iatrogenic harm.