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Quality Improvement Then and Now: How AI is Transforming Surgical Quality

Quality Improvement Then and Now: How AI is Transforming Surgical Quality

The concept of quality improvement in the medical field is not new. In fact, Florence Nightingale herself was an early pioneer of the practice. Of course, times have changed immeasurably in healthcare since the 19th century. Given the advanced technologies that are now widely available for surgical care, most notably AI, the opportunity exists to take quality improvement to the next level. But how?

The Continuous Quality Improvement Process

Enter continuous quality improvement (CQI). This modern approach to quality improvement encourages medical teams to continuously ask:

  • How are we doing?
  • Can we do it better?
  • Can we do it more efficiently?
  • Can we be more effective?
  • Can we do it faster?
  • Can we do it in a more timely way?

In healthcare, the Plan-Do-Study-Act (PDSA) method is often employed to achieve CQI. By completing iterative cycles, the PDSA approach aims to continually build knowledge and institute changes that improve quality on an ongoing basis over time. 

However, the traditional approach to PDSA quality improvement yields only marginal results. Although many projects report successful quality improvement, low adoption to the methodological features of this approach calls the legitimacy of this method into question.

Automated Analytics Throughout the Patient Journey

This is exactly where AI is poised to disrupt the CQI landscape. While the standard approach to PDSA cycles involves collecting and analyzing data manually, the key advantage of AI is its ability to perform these tasks automatically and quickly. 

In the surgical realm, AI can provide particular value by linking what happens in the OR to patient outcomes following completion of a case. For example, Theator’s Surgical Intelligence platform is capable of recording cases, identifying best practices, scoring case complexity, mapping key procedural steps, detecting instruments, noting operative events, and measuring idle time.

Real world examples demonstrating improved quality based on Surgical Intelligence insights have already been documented. One institution improved achievement of surgical practices related to anatomic identification in laparoscopic cholecystectomy from 39% to 69% in just 3 months

Furthermore, better intraoperative technical performance, as documented by intraoperative video recording, has been linked to improved patient outcomes, including fewer postoperative complications, reoperations, and readmissions.

Actionable Insights for Improving Patient Outcomes

By harnessing the power of AI technology at each stage in the care of a surgical patient, healthcare organizations and surgeons can acquire a substantial amount of data that can then be analyzed to link intraoperative performance and events to individual patient outcomes. This information can then be leveraged to inform clinical surgical practice and make continuous improvements over time. 

Importantly, this exponential increase in available data comes without additional effort by team members. In addition, the nature of AI-based surgical intelligence reduces the risk of bias that is inherent in manual data collection. 

The results to date on this growing application of AI to improve continuous surgical quality improvement speak for themselves. The days of Florence Nightingale and PDSA cycles are over. The modern approach to CQI is driven by AI; innovative organizations are rapidly adopting this approach, and their patients are benefitting from the results. Check out our Beginner’s Guide to AI in Surgical Care to learn more!

The Benefits of Fully-Managed Surgical Intelligence

Ready to Upgrade Your Operating Rooms with AI?

If you’re upgrading your OR to take advantage of the many benefits of AI technology for patients, surgeons, and healthcare organizations, don’t make the mistake of only considering how and what a particular platform records. The question of what happens to all of your recordings is just as (or maybe even more!) important as what and how you record.

  • Where will recorded data be stored?
  • Will this sensitive data be secure?
  • Will storage be onsite, or can it be cloud based?
  • Will data storage cost extra, or is it included in your platform?

Knowing why these considerations are important and how to ask the right questions before investing in technology that isn’t the right fit for your organization can save a lot of headaches and money down the road.

Data Storage

Before investing in technology to record and analyze surgical video, it is essential to consider all aspects of data storage. Surgical video is not only needed for immediate review of cases and association with post-operative outcomes, it will also be part of a patient’s medical record and stored indefinitely for record keeping and legal purposes. 

 

This means significant storage space is needed, especially if you will be recording high-quality video. Investing in on-premises servers and managing your own storage requires considerable space and is extremely costly—averaging about $500k per year. In contrast, cloud-based storage is more secure, and eliminates the need for those costly investments. 

 

As you can see, the question of where and how to store surgical video is going to affect the all-in price of the technology you choose. Some platforms, such as Theator’s Surgical Intelligence platform, offer unlimited cloud-based storage as part of our package. No hidden fees or need to upgrade once you’ve reached a certain point, unlike our competitors. 

Data Security

Like any other identifiable patient information, stored surgical video must meet the highest privacy and security standards. In the case of surgical video, it’s also important to ensure that only the surgical field is captured in recordings to further maintain privacy of patients and staff.

One way to limit recording outside of the surgical field is to use technology that identifies and blurs out-of-body segments of surgical video. This is exactly the technology that Theator uses in our platform—with 99.5% accuracy, the highest in the industry—where privacy and security are top priorities.

Security certifications are a key indicator that a surgical intelligence platform meets industry-leading security standards. Theator is the only platform with both HITRUST and SOC2 Type 2 certifications and we are HIPAA compliant, so patients and staff can rest assured their privacy is protected.

Think Big Picture for Surgical Intelligence

Here’s the bottom line: if you’re making a large investment in a surgical AI platform, be sure to consider every aspect of the product from start to finish first. The platform’s performance in the OR is of course paramount, but it’s also crucial to consider what happens to your recorded content after each case. Otherwise, you may be left with substantial ongoing costs, and challenges that could undermine 

Use our AI Technology Evaluation Checklist​ to help. 

Taking Surgical Quality Improvement to the Next Level

Taking Quality Improvement to the Next Level

There will always be some degree of variability in surgical practice. Every procedure and surgeon has unique characteristics that make this inevitable. However, there are many circumstances in which surgical variability is a red flag that there is room for improvement. If Surgeon A is taking twice as long to complete the same procedure as Surgeon B, this is likely to affect quality of care and surgical outcomes, and interventions to address this discrepancy could improve these parameters.

 

Luckily, equipping your OR with Theator’s Surgical Intelligence Platform offers a simple and  transformative solution to this complex issue. Only Theator’s state-of-the-art platform provides  the comprehensive tools needed to identify surgical variability, connect this information to surgical outcomes, and offer custom solutions to improve practice and standardize care.

 

Are you wondering how we do it? Here’s what our technology offers that you won’t find anywhere else.

Intraoperative Intelligence

Theator’s technology begins recording procedures automatically, eliminating the possibility of human error resulting in missed recordings. Once a procedure begins, real-time feedback and updates are instantly available to those in the OR and other key team members, such as attending physicians and charge nurses. This means faster reaction times when unplanned events occur and increased OR efficiency as staff are kept informed of case progression.

 

Because Theator’s platform can identify procedural steps as they occur, recorded cases are tagged by key moments, making them easy to review for educational and quality improvement purposes. In addition, our technology is compatible with any device, so you have multiple options for watching and reviewing cases from the hospital or on the go. 

EHR Integration

Identification of intraoperative steps is an excellent first step toward reducing surgical variability. However, without connecting surgical events to patient outcomes it’s impossible to know if practice changes are truly moving the needle on quality of care.


That’s why our platform seamlessly integrates with your EHR system. By automatically connecting surgical events to patient outcomes, our technology can identify disparate outcomes related to surgical variability and easily track changes over time as improvement efforts are implemented.

AI-Powered Analytics

It goes without saying that taking the time to manually review recorded surgical video and connect intraoperative events with patient outcomes would be impossible for any surgeon. That’s where AI tools provide the support needed to harness and analyze the vast volume of data in recorded procedures to generate customized and meaningful insights for individual and systemic improvement.

Our dashboard offers each surgeon analytics about their individual cases and patient outcomes and how their results compare to their peers. By providing granular information about surgical variability, surgeons can then use these insights to adjust their practice and follow changes in their outcomes over time.

Choose Surgical Intelligence That Meets Your Needs

Other surgical AI platforms promise recorded video that will improve surgical care. However, this usually comes with a catch. These other platforms often don’t integrate with all the hardware and software you already have in your OR, don’t connect with your EHR to link surgical events to patient outcomes, or don’t have advanced AI tools to analyze data and offer personalized recommendations for improvement. When it comes to updating your OR to best meet the needs of surgeons and patients, be sure to choose a surgical intelligence platform that checks all these boxes so you can improve quality and optimize patient outcomes instead of just gathering data.

Ready to adopt surgical intelligence in your operating rooms? Make sure to use our AI evaluation checklist when evaluating different technologies. Get the checklist here.

Choose the Product That Captures ALL Your Surgical Video

Theator: The Product That Captures ALL Your Surgical Video

Leaders across the surgical profession are upgrading their operating rooms to incorporate innovative AI technologies that improve surgical care. If you’re among these forward-thinking leaders, you may be wondering how to choose between available technologies and which benefits one solution offers over another. 

 

Here’s what Theator brings to the table that you won’t find anywhere else.

Compatibility With Existing Equipment

Many surgical AI tools on the market are only compatible with their own OR hardware or software. Not only can this mean bigger upfront costs, it can also cause you to miss out on valuable surgical data if all of your hardware and software isn’t compatible with their technology.

 

With Theator, you never need to worry about this issue because our Surgical Intelligence Platform is compatible with any and all hardware and software you’re already using in your OR. When you partner with Theator, you won’t encounter any upfront costs or delays related to compatibility issues. 

Capture ALL Your Surgical Video

Ensuring compatibility of your surgical AI platform with your existing hardware and software is the first critical step toward capturing ALL of your surgical video going forward- not just some of it. You might be wondering why capturing all your surgical video is so important. The answer is simple: more data = more opportunity to improve quality and outcomes.

 

Recorded surgical video improves care from multiple angles. First, trainees (and even experienced surgeons) can review cases to continuously improve their technique and decrease errors. In addition, a greater volume of recorded surgical video means more data that can be mined to identify patterns and systems issues affecting care. 

 

Theator provides two key features related to surgical video recording that set us apart from the competition. Our Surgical Intelligence Platform automatically records every surgical case when it begins. No additional steps or room for human forgetfulness. 

 

Additionally, our AI technology provides real-time updates and feedback to improve efficiency and alert surgeons to critical intraoperative events as they occur. This means no time-consuming manual review of video footage is needed. Our AI-assisted Platform can identify practice variability, support clinical decision making, and immediately provide the information you need to improve patient outcomes.

Bring Your Operating Room Up to Speed

Partnering with Theator to upgrade your ORs using our universally compatible Surgical Intelligence Platform means capturing six times more surgical video than you would with our competitors. That’s six times the amount of information at your fingertips to increase transparency, enhance medical education, identify practice variability, and improve clinical decision making, quality, and patient outcomes. 

 

With so many benefits to surgeons and patients, the choice in surgical AI technology is clear. Reach out today to book a demo and learn more about what Theator can do for you.

Three Benefits of Recording Surgical Videos

Three Benefits of Recording Surgical Videos

Intraoperative video recording is quickly becoming the standard of care across surgical specialties, and with good reason. Recorded surgical videos are a valuable educational tool for trainees and experienced surgeons alike and improve the transparency and quality of care provided in the OR. Let’s take a deeper look at what this means for day-to-day surgical practice and patient outcomes. 

1. Recording Surgical Video Provides More Transparency

Improving transparency regarding surgical practices is important for both surgeons and patients. Patients experience anxiety about undergoing surgery and are interested in understanding what happens when they are under anesthesia. 

 

For surgeons, having recorded surgical video available for review is an invaluable tool for managing postoperative patients. One surgeon whose hospital has been automatically recording all surgical video for over a decade described a patient who had undergone emergency surgery the night before, but was worsening the next day. 

Upon review of the recorded surgical procedure, it was noted that a small bowel perforation was missed the prior night. Without the benefit of recorded surgical video, determination of the cause of the patient’s worsening would likely have taken much longer. A study of recorded bariatric surgeries found similar benefits in identifying postoperative complications by reviewing recorded surgical video. 

Notably, the surgeon mentioned above also reported there were “three or four” instances of recorded surgical video being submitted for legal cases over the decade since they began automatically recording. In each instance, the case was settled in favor of the hospital. 

2. Recorded Surgical Footage Can Be Used For Training & Education

Recorded surgical video provides the opportunity for trainees to gain exposure to exponentially more surgical procedures than they are otherwise able to by only attending procedures in person. Surgical residents with access to recorded surgical videos report accessing them to prepare for upcoming cases, improve their surgical anatomical knowledge, and review cases in which they participated to solidify their skills. 

 

Importantly, the use of surgical video to prepare for surgical cases has been associated with a decreased procedural error rate when performing the procedure that was studied. Taking recorded video to the next step in surgical training, cases performed by residents that are recorded can later be reviewed by multiple surgeons for feedback and evaluation.

 

The educational benefits of recorded surgical video don’t end with trainees. Even experienced surgeons benefit from refining and continuously improving their skills, and studies suggest that self-evaluation is not the best method of skills assessment. The objective data provided by surgical video recordings can provide the necessary data for surgeons to make actionable changes.

3. Surgical Video Provides Information Needed For Quality Improvement

The bottom line is that surgical video recordings are enormous sets of data that provide otherwise unavailable information about what occurs in the OR. For surgeons and hospitals looking to improve the quality of care they offer, recording surgical video is the first step in gathering the data needed to do this. 

Consider the current use of patient outcomes to drive quality improvement initiatives. Without intraoperative data, how can a link (or lack thereof) between what happens in the OR and patient outcomes be established? Often, it cannot. 

In this realm, there is an opportunity to pair recorded surgical video with AI technologies to gain deeper insight into practice variability and surgical outcomes than is possible with manual review alone, which is inherently limited by time and cost restraints.

AI tools paired with surgical video recording can identify steps in a surgical procedure, offer suggestions for clinical decision making, and enhance intraoperative diagnosis. The integration of such tools into everyday surgical care provides the specific feedback needed to improve patient outcomes.

Why Aren’t All Surgical Videos Recorded?

Simply put, automation is the key to success with surgical video recording. Without automation, surgeons are unlikely to remember to manually record each procedure they perform when it involves an additional step to everything else they are doing to prepare for a case. Investing in a technology that offers automatic recording is an essential step in collecting surgical data and improving outcomes. 

Failing to Record Surgical Video Leaves Valuable Data on the Table

If your institution isn’t currently recording all surgical procedures, you are lacking a large and essential data set that can be used to improve quality, transparency, education, and patient outcomes. Especially given that video is already used regularly in laparoscopic and endoscopic procedures, integrating software that automatically records video from tools already in use is a simple step that can result in a great leap forward in your institution’s technological, safety, and quality capabilities. Knowledge is power, and recorded surgical video gives your institution the power to create a culture of continuous improvement that benefits patients and surgeons. 

Considering AI in your operating room? Get our AI Technology Evaluation Checklist​:

Do Patients Want AI in the Operating Room?

Do Patients Want AI in the Operating Room?

Short answer: Yes! 

 

In fact, not only do patients place a high importance on choosing where to get surgery based on their innovative nature and adoption of technology, but half of patients believe they will receive better care if that is the case.

 

Much of the literature about implementing AI technology in the OR views the issue from the perspective of the physician or healthcare organization. And while patient outcomes are a key force driving this discussion, patient opinions are rarely part of the conversation. So how do patients feel about the use of AI technology during their own surgical procedures? The answer may surprise you. 

Surgery Is Already A Difficult Decision For Patients

Unsurprisingly, patients do not take the decision to undergo surgery lightly. Furthermore, most have understandable concerns about surgical risks and complications. In our 2023 survey of 200 post-operative patients, 82% of patients reported they were nervous to undergo surgery. Specifically, 65% worried about dying on the table and 66% were concerned their surgery may create more health problems. 

 

 

In fact, our data show that patient preoperative anxiety is not misplaced. While 93% of those surveyed were pleased with their surgical outcomes, 26% of this group experienced post-surgical issues that required further intervention to correct.

Choosing Surgeons and Hospitals

What factors go into a patient’s decision about where to have surgery and whom to trust with their care? A vast majority of patients (87%) trusted their surgeon prior to undergoing their procedures. This trust largely carried through to the post-operative phase, even for those who experienced complications they believed could have been prevented. Interestingly, 21% of patients felt their surgeon did not clearly explain what to expect, yet clearly still trusted them.


In terms of surgical location, access to the most advanced technologies was the most important factor patients considered when deciding where to undergo surgery. This outranked consideration of the hospital where a physician practiced and where the surgeon was trained. Patients see the value in innovative care and are willing to forgo institutional loyalty to access advanced technologies.  

Intraoperative Video Recording and AI

According to our results, a majority of patients (55%) wished their surgical procedure had been recorded and placed high value on the potential uses of recorded surgical data. Of the patients surveyed, 60% would want to watch the recording of their surgical procedure if it were available. Additionally, 38% wish they knew more about what happened in the OR during their procedure and 58% of those who experienced complications (15% of total respondents) felt their complications were avoidable, which may explain their interest in viewing their own procedure. 

 

Notably, patients are not simply interested in the potential for recorded surgical video to demonstrate what took place during their own procedure — they see the value in using recorded surgical data for quality improvement. In this regard, 76% of respondents believed that surgical video should be captured and used to better understand surgery. 

 

When asked about the use of AI tools in the operating room, 50% of those surveyed felt they would receive better care if advanced technology like AI was used in the operating room. This means that when patients are selecting a hospital for their surgical procedure, many see the use of AI as exactly the type of high-value advanced technology that would warrant choosing one hospital over another. Rather than being wary of these tools, patients see the potential for them to support surgical decision making.

Surgical Expectations and Outcomes

A majority of respondents believed that surgeons should be measured on complication and readmission rates, as well as length of stay. Of note, 72% of patients surveyed experienced a length of stay that was expected or less than expected. 

When asked how their surgical experience could have been improved, patients cited the following:

    • Knowing my surgeon is using the most advanced technology (47%)
    • Knowing my surgeon is being assessed based on their postoperative outcomes rather than cost (46%)
    • Having more visibility into what happened while I was asleep in the operating room (41%)
    • Being at a hospital known for having the most advanced technology (32%)

Insights for Future Decision Making

Patients are consumers of healthcare and have high expectations for the level of surgical care they receive. Rather than being viewed as risky, technological innovations in surgical care, such as the use of AI tools, are viewed by the general public as not only desirable, but a feature worth seeking out when deciding where to obtain care.

 

As physicians and hospital administrators make decisions about how and when to integrate AI tools into their ORs, it is essential to keep this patient perspective in mind. Just as those in the healthcare sector see the potential for AI to improve patient care, so do patients, whose interest in advanced surgical technologies is likely to grow as these tools become more widely available.

Surgical Outcome Reports Aren’t Enough

Improving The Modern Surgical Outcomes Report

In recent decades as evidence-based medicine became the standard of care, physicians and hospital systems turned to outcomes reporting as a means of indirectly measuring quality of care. Such information, especially when it is publicly available, allows for the transparency necessary to assuage patient concerns about the quality and safety of medical care and provides a basis for identifying systemic and individual opportunities for improvement. 

 

No other area of medicine lends itself to outcomes reporting and tracking quite as well as surgery. The universal nature of surgical procedures allows for standardization of outcome metrics, and the inability of patients to provide an account of surgical occurrences reinforces the need for maximal transparency to monitor quality.

 

While outcomes reporting plays an undeniable role in improving care, as we enter the era of surgical AI augmentation, the time has come to ask ourselves whether outcomes reporting is enough. With so much data now at our fingertips, how can it be harnessed to increase transparency and further improve outcomes?

The Actual Impact of Reporting Surgical Outcomes

The use case for surgical outcomes reporting came from cardiothoracic surgeons in the UK. This formal reporting process was born out of public pressure related to high mortality rates of pediatric patients in the region undergoing cardiothoracic surgery. With all pediatric cardiac units required to participate in outcomes reporting, mortality decreased 75% between 1985 and 2002. 

 

Following this, the Society for Cardiothoracic Surgery in Great Britain and Ireland began publishing hospital- and physician-specific data in 2005, resulting in a 50% reduction in risk-adjusted mortality. Since 2005, seven additional surgical specialties in the UK started publishing their outcomes data.

 

This practice has a number of advantages, most especially for patients for whom the transparency of outcomes reports provides trust and autonomy in their healthcare decision making. Surgeons also benefit from outcomes tracking, which allows identification of hospitals and surgeons with the best outcomes who can, in turn, inform best surgical practices. Additionally, publishing outcomes data provides a transparent piece of the complex puzzle that is healthcare costs.

Surgical Outcome Reports Don't Tell The Whole Story

Without an automated means of capturing outcomes data, continued dependence on human reporting will be inherently suboptimal due to incomplete recall and documentation. 

 

Related to this is the fact that outcomes alone do not take into account patient-specific pre-surgical risk and other factors that affect the complexity of a case. In other words, the intraoperative death of an 85-year-old patient with multiple comorbidities is clinically different from that of a 25-year-old previously healthy patient undergoing the same procedure. While some outcomes reporting systems attempt to account for this risk difference with adjusted scores, there is no perfect way of representing these factors

 

In addition, outcomes reports are inherently inaccurate to a certain extent due to their dependence on retrospective reporting. One study found that routine reporting by surgeons identified only 62% of adverse outcomes and even medical chart review identified only 78%. 

Without an automated means of capturing outcomes data, continued dependence on human reporting will be inherently suboptimal due to incomplete recall and documentation. 

How Do We Go Beyond Outcomes Reporting?

Outcomes reporting provides an important level of professional and public transparency that can build patient trust and potentially result in practice improvement. However, the latter is not a guaranteed result of outcomes reporting alone. One study that compared 263 hospitals that participated in The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to 526 that did not found no statistically significant improvement in outcomes across a 3-year period at participating hospitals, leading the authors to conclude that feedback on outcomes alone is not enough to prompt improvement.

 

For outcomes to serve as meaningful tools for improvement, they must be associated with additional information that tells the story behind how and why an outcome occurred. For surgeons, this data lies mainly in the events that occur in the OR during a surgical procedure. Intraoperative video recording offers a goldmine of data that, when paired with information about surgical outcomes, can provide the key to translating these outcomes into improved surgical practices. 

 

The concept of recording all surgical procedures as standard practice has understandably been met with trepidation by some surgeons. After all, as Alexander Langerman, MD states, “no one wants to fall below the bell curve.” This, coupled with the litigious nature of today’s healthcare system, can lead surgeons to disproportionately focus on the risks of transparency while disregarding the benefits. 

 

However, the benefits of intraoperative video analysis are well documented. For example, one study that used AI to analyze hundreds of intraoperative hysterectomy videos in search of practice differences to explain variability in outcomes found that not all surgeons were performing the recommended step of identifying the ureters during the procedure. This critical part of a hysterectomy procedure is key to preventing ureter injuries, and yet it was not being consistently performed. 

 

This is only one example of how AI analysis of intraoperative video can serve as an essential component of the quality improvement process. AI offers the ability to review and analyze surgical video in a manner that is impossible for surgeons to do manually due to time constraints. Without this tool and the transparency it offers, the reasons behind variability in surgical outcomes cannot be easily identified, and the practice modifications needed to improve these outcomes will remain a mystery.

Taking Transparency to the Next Level

Digital tools, including AI technologies that analyze intraoperative surgical video, are no longer the wave of the future. Instead, they are already present in ORs and being used by surgeons who see the value they offer in increasing transparency, identifying practice variability, and improving outcomes. The takeaway in the dawning of this new era in which medical care and technology are more intertwined than ever is that increasing transparency by embracing these tools will be a defining characteristic of surgeons who strive to continuously improve, and those who do not embrace these technologies will be left behind. 

How AI Can Improve Surgical Care

How AI Can Improve Surgical Care

Although the ultimate role of artificial intelligence (AI) in surgical care is still evolving, one thing is clear: AI is here to stay. The potential advantages AI tools offer to process large amounts of data and generate meaningful information that can improve patient outcomes means that its integration into surgical care has myriad potential benefits. Read on to learn what they are!

How Can AI Tools Be Integrated Into the OR?

To understand how AI technology can be used to improve patient care, it’s important to first understand how AI tools can be incorporated into current surgical workflows. Because the power of AI rests in its ability to rapidly process large data sets and produce reasoned output, data that is currently routinely being captured in ORs in the form of intraoperative video recordings can serve as the input for AI tools. These specially trained programs can then process this input and generate feedback for surgeons and OR staff to improve surgical workflow, technique, and quality. 


The first step in generating useful information from surgical video recordings is teaching these AI tools to accurately identify the steps of a surgical procedure. Currently available technologies have already demonstrated the ability to perform this task in different surgeries. One study that analyzed the recognition of surgical steps in recordings of 619 totally extraperitoneal (TEP) inguinal hernia repairs found per-step identification accuracy to be as high as 94%. Another study demonstrated successful real-time annotation of two separate urologic procedures.

What’s Next for Surgical AI Technology?

Now that we know AI tools can identify surgical steps, how does this information benefit patient care? Here are just a few of the multiple ways this data can be harnessed.

Workflow Optimization

By accurately identifying surgical steps and segments of surgical procedures, AI tools can provide real time predictions of factors that affect OR workflow efficiency, such as the amount of time remaining in a case. 

Accurate prediction of such metrics allows staff and anesthesiologists to better plan patient flow and make the best use of daily OR time, an especially valuable proposition in the dynamic environment of busy ORs. In difficult or complicated cases, AI technologies may someday even have the ability to trigger an alert for extra support or surgical backup based on variations noted in surgical segment identification.

Landmark Identification​

Correct identification of anatomical landmarks during surgery is key to preventing medical errors. Just as AI tools are able to accurately recognize surgical segments, they can also assist with identification of critical anatomical structures. By doing so, this augmented technology can aid with reducing misidentification and enhance patient safety.

One example of this technology in action is the use of an AI tool to identify the Critical View of Safety during laparoscopic cholecystectomy, a widely agreed upon surgical best practice. After training on 2,000 surgical videos, this technology was able to achieve 84% accuracy in detecting the Critical View of Safety.

Clinical Decision Support​

A natural extension of the ability of AI tools to mark surgical segments and identify landmarks is the processing of this data to offer real time intraoperative feedback and guidance to surgeons. Based on anatomical data, AI technology may be able to provide updated predictions of surgical risk that augment those done preoperatively based on patient characteristics and risk factors alone.

Furthermore, the ability of AI tools to predict next surgical steps means they can offer suggestions on how to proceed based on their previously programmed data. This feature may be especially valuable for trainees who require additional guidance until they reach a sufficient experience level.

Operative Report Creation ​

Operative reports are a necessary part of surgical care. However, they are also a task that takes physicians away from patient care, and they do not always accurately reflect each step that took place during a procedure. This often makes them less than useful as both a medical-legal document and a learning tool.

Given the ability of AI tools to track surgical segments, it follows that these documented steps can then be compiled into an accurate and timely operative report. One study of this technology found that an AI tool reproduced major components of operative reports 91% of the time across 117 cases. This holds great promise for both reducing physician administrative burden and improving surgical transparency.

The Future of Surgical AI Tools

By processing and analyzing intraoperative video recordings, AI tools can assist in detection of  anatomical landmarks, achievement of surgical best practices, and real time clinical decision making, operative report generation, and maintenance of an optimal workflow. However, this is just the tip of the iceberg in terms of what AI is likely to bring to future surgical care. By augmenting the knowledge and experience of trained physicians with the power of large data sets, technologies such as these are poised to improve quality of care, patient safety, and clinical outcomes. 

The Role of AI in Quality & Safety Improvement​

The Role of AI in Quality & Safety Improvement

In the matter of a few years, artificial intelligence (AI) has gone from being a topic discussed only by select innovators in the healthcare industry to one of widespread interest and endless discussion. In fact, one study found that the number of publications about AI doubled in the medical literature between 2014 and 2018.

However, it’s always important to remember that quantity does not equal quality. In other words, AI tools are only worthwhile in healthcare if they improve patient outcomes. So what currently available AI technologies improve quality and safety of care? And what does the future of AI-assisted quality improvement look like? Let’s dive in!

Predictive Analytics

While patient safety techniques have traditionally focused on identifying events and near misses after the fact and working to prevent future repeat occurrences, the introduction of AI-powered predictive analytics flips this concept on its side by allowing identification of potential patient safety issues before they happen.

One example of this is an AI tool used at NYU’s Langone Medical Center to predict hospital readmission rates, a vital patient safety and care quality measure. This technology is able to predict 80% of readmissions and performs 5% better than standard computer tools at calculating readmission risk. 

In the surgical realm, predictive analytic tools can improve patient outcomes by triaging surgical patients to the most appropriate postoperative location more reliably than traditional methods*. This can lead to significant improvements in patient safety, as patient undertriaging to a surgical floor instead of an ICU is associated with a longer length of stay and higher mortality rate, among other poor outcomes.

Clinical Decision Support

AI technologies have the power to offer clinical decision support in a manner not previously possible: at the time of decision making, using personalized and up-to-date patient data. Furthermore, AI tools that support clinical decision making have expanded in availability from a few select specialties to nearly all fields of medicine.

Radiology was an easy early target for AI technologies given the technological nature of the field. And while it’s unlikely that AI will ever replace radiologists, use of AI-powered diagnostic tools to augment radiologist readings has been associated with reduced diagnostic errors, with one study showing a 19% reduction of this metric. This not only improves quality by increasing diagnostic accuracy, it also saves money by reducing the cost of unnecessary tests. 

In surgical care, AI tools that offer decision support using real time intraoperative data can improve patient safety by assisting with the identification of critical landmarks for injury prevention. One study evaluating the use of AI in detecting the Critical View of Safety in laparoscopic cholecystectomy found this method to have an 84% accuracy rate. Similar intraoperative AI-guided landmark identification was evaluated during endoscopic hysterectomy and also associated with improved safety awareness and reduced intraoperative complications.

Medical Education

Creating a safe environment for trainees to gain necessary skills and knowledge for practicing medicine in the real world is an area where many have tried to innovate over the years. From simulation labs with mannequins to online fictional patient case scenarios, computer-assisted technology has undoubtedly enhanced the ability of students and residents to learn without putting patients in danger. 

AI tools take this concept to the next level by providing guidance and feedback using real patient data, rather than simulations, for enhanced learning. For example, AI virtual patient tools analyze large data sets from actual patients to create true-to-real-life cases for medical students to work through. This not only improves the quality of their training, it also saves valuable time previously spent manually generating such mock cases.

For surgical trainees, harnessing intraoperative recordings and pairing them with AI technology offers a new method of learning and feedback on surgical performance. Identifying critical procedural elements and decision points using AI allows surgical residents to learn from the cases they perform after the fact and use this information to improve the quality of their technique and decision making for future cases.

Improving Quality and Safety Into the Future

The promise of AI for improving healthcare quality and safety lies in its ability to operate in real time, using current patient data to provide assistance and support. This greatly contrasts with traditional models of quality and safety improvement that rely on manual reporting of data with analysis after events have already occurred. Therefore, AI has the power to improve patient care and outcomes in real time, rather than simply using past data to prevent future mistakes.

 

* Loftus TJ, Ruppert MM, Ozrazgat-Baslanti T, et al. Association of Postoperative Undertriage to Hospital Wards With Mortality and Morbidity. JAMA Netw Open. 2021;4(11):e2131669. doi:10.1001/jamanetworkopen.2021.31669

 

I. Levin, Y. Gil, A. Cohen, 7722 Improved Safety Awareness and Intraoperative Complication Reduction after Implementation of Artificial Intelligence in Hysterectomies, Journal of Minimally Invasive Gynecology, Volume 29, Issue 11, Supplement, 2022, Page S101,ISSN 1553-4650, https://doi.org/10.1016/j.jmig.2022.09.325.

The Role of Artificial Intelligence in Healthcare

The Role of Artificial Intelligence in Healthcare

The release of ChatGPT’s artificial intelligence took the world by storm in 2022, leaving most casual users amazed at the type of content it could produce. Want to build a customized workout plan? Check. Want to rewrite your resume? Check. A list of topics for a dinner party or work lunch? Check and check. While it’s clearly impressive that ChatGPT has knowledge on an unfathomable number of topics, its primary awe-inspiring feature is its ability to rapidly create novel content that generally reads as if it was written by a human.

 

This revelation set off ongoing discussions in nearly every field about the opportunities, threats, risks, and benefits of AI technology. Healthcare is no exception to this discussion, especially given the high-stakes nature of patient care. So how exactly can we expect AI to be used (and not used) in the healthcare industry?

What is Artificial Intelligence?

Before jumping into the role of AI in healthcare, it’s important to understand what defines artificial intelligence. The original concept of AI dates back to 1956, when John McCarthy described it as the science and engineering of making intelligent machines. On a big picture level, AI refers to technology that is able to perform tasks that typically require a human level of intelligence and insight.  

All AI technologies have the same foundational mechanisms. They are programmed with sets of data to develop algorithms that allow them to quickly generate output based on pattern recognition. AI tools like ChatGPT are programmed with enormous data sets. This is why they are capable of both generating your grocery list and recommending the next book you should read. Other tools, such as those used in the healthcare industry, are programmed on more limited data sets related only to their intended use. So while the “A” in AI stands for artificial, in reality it functions more as augmented intelligence that helps humans perform all kinds of tasks.

How is AI Used in Healthcare Today?

Although the term “artificial intelligence” still has a futuristic ring to it, the truth is that AI has been used in the healthcare setting for decades. Current uses of AI in healthcare include data analysis, clinical decision support, and disease diagnosis and treatment, among others.

 

Radiologists were early adopters of AI tools, which makes sense given the technology-forward nature of their work. As of 2020, the American College of Radiology reported that 30% of radiologists had adopted AI technologies. AI tools are currently being used by radiologists to detect intracranial aneurysms and pulmonary embolisms. Furthermore, they supplement routine radiologist workflows by tracing tumors and measuring the amount of fat and muscle on a CT.  

 

Another example of the current role of AI tools in healthcare is the use of natural language processing in clinical documentation. Natural language processing describes the way in which technologies like ChatGPT can interpret typical human language input to generate meaningful output. Tools like Nuance’s Dragon Ambient eXperience are able to transcribe a patient/clinician interaction and use this information to generate appropriate electronic clinical documentation.

What’s the Future of AI in Healthcare?

If you’ve ever used Siri on your iPhone, had Netflix suggest movies you may like, or used Google Maps to get to your destination, then you already know that AI technology is here to stay, and the healthcare sector is no exception to this. So what does this mean for the future of medical care and those who provide it?

 

Most experts agree that AI will not replace doctors or other healthcare professionals, and it’s unlikely that patients will be scheduling visits with a ChatGPT-like bot anytime soon. Instead, AI technology will be used to enhance processes and workflows, improve quality, and assist with making sense of the massive sets of patient data that exist in healthcare organizations. 

While any new technology used to provide patient care requires meticulous vetting and consideration of its ethical implications prior to widespread use, the benefits that high-quality AI tools can offer in the healthcare industry have the potential to substantially improve care delivery and reduce costs and administrative burden.

Cost Reduction:

It’s no secret that the US spends more money on healthcare than other economically similar countries. AI technologies that automate, streamline, or improve processes can reduce healthcare costs. For example, one healthcare system noted a savings of $3 to $4 per visit when they changed to an automated scheduling system.

Improved Patient Care:

AI-powered patient monitoring tools offer the ability to not only monitor metrics such as vitals signs, but also to take that data to the next level by looking for patterns that may indicate an impending medical emergency. Such tools are being developed for use both in the hospital setting and for home monitoring of patients. 

Reduced Physician Burnout:

Burnout notably affects a significant number of doctors, nurses, and other healthcare professionals, which has the downstream effect of growing numbers of healthcare workers leaving their jobs. Therefore, AI tools that can alleviate pain points that contribute to burnout, such as time spent on clinical documentation, can serve to reduce this threat to the healthcare workforce. For example, an AI tool that collects patient health information in advance of a doctor’s visit and automatically generates clinical documentation was shown to reduce intake and documentation time by 90%.

Enhanced Quality & Safety:

AI’s ability to quickly analyze large sets of data leads to important implications for patient safety and quality of care. Examples of this include AI tools that accurately predict which patients are developing hospital acquired infections and others that monitor hand hygiene practices and provide reminders to clinicians to improve compliance.

AI in Healthcare: The Future is Now

Current trends in the development and implementation of AI in the healthcare setting all point in the same direction: AI is here to stay. AI tools offer the potential to address some of the most pressing concerns in today’s healthcare industry, including rising costs, physician burnout, quality, and patient safety. In particular, one area of healthcare that is ripe for disruption with AI is surgical care

While the adoption of AI technologies in healthcare should be held to the same standards the industry uses for other elements of patient care, such as drugs and medical devices, it’s clear that organizations that are slow to adopt AI as it becomes mainstream may be left significantly behind their competitors. Therefore, the time is now for healthcare leaders to explore evolving technologies and the potential solutions they may offer. 

Three steps for hospitals and surgical teams to start reducing surgical variability today

What can hospitals and surgical teams start doing right now to reduce surgical variability?

Short answer – not a lot, at least not a lot without the help of technology.

Hospitals are grappling with variability in surgical outcomes, yet the ground truth, aka surgical video, is not routinely captured. And even if it is captured, surgeons are busy, and don’t have time to analyze all of that raw video data.

So what steps can hospital executives, administrators, and surgical teams start taking now to tackle surgical variability and all of its damaging effects?

Step one: Capture better data

Especially for minimally invasive procedures (both laparoscopic and robotic), where surgery is visually guided and therefore a camera is already there. Simply fostering a “culture of capture” for every procedure, whenever possible.

Automating capture is key to success:​

As creatures of habit, changing institutional culture and habits can be a difficult task. At Theator, we’ve seen this first hand – this is why our Surgical Intelligence Platform doesn’t have a record button, it starts recording automatically.

Before implementing our automatic recording feature we were shocked to see the number of videos that weren’t being recorded. Even though the benefits were clear, and the technology was readily available to surgeons in the operation room. It became clear that automating this function was key to fostering a culture of capture. 

Step two: Mine recorded surgical data

Once hospitals have created a ‘culture of capture’ they can mine the surgical footage to surface where variability exists intraoperatively to identify opportunities for improvement. This will make it possible to set specific goals and monitor adoption to programs put in place to achieve them. This entails reviewing, annotating or structuring the data, and compiling data points to make analysis possible.

Step three: Take advantage of new tech solutions

Hospitals must take advantage of new tech solutions to help. Sifting through all that surgical video manually can be extremely time consuming and resource-intensive, but there are platforms available now that can do it all for you — and connect the data to patient outcomes.

The ability to connect what happens intraoperatively to a patient’s recovery postoperatively, generates hospital- and surgeon-specific insights on how to improve the quality of surgical care.  

Ready to start reducing variability?

Download our Beginners Guide to Surgical Variability eBook:

 

Surgical Variability’s Impact on The Entire Healthcare Ecosystem

The impacts of surgical variability extends far beyond individual procedures

Simply put, “surgical variability” means not all surgeons perform surgery exactly the same way. Because of the many factors contributing to variability between procedures, reducing variability is a challenge hospital administrators are painfully aware of. Some causations are obvious, like patient factors or healthcare inequity. While others are more opaque—like subjective experiences between surgeons, or a lack of actionable data

The effects of surgical variability at every level of the healthcare ecosystem are significant and wide-ranging. It’s no wonder that executives, administrators, and surgical teams have long been in search of reliable ways to reduce or eliminate it altogether.

Variability in surgical care often leads to preventable complications and poor outcomes, but patients are not the only ones feeling the negative impacts of surgical variability…

To patients surgical variability can mean life or death

Obviously the group hardest hit by disparities in surgical care is patients. The worst case scenario for them, of course, is preventable death. But even unforeseen complications resulting in longer hospital stays, additional health issues, or the need for reoperation can take a massive toll. Patients miss work, incur huge hospital bills, have their lives interrupted, endure pain, discomfort, and lack of privacy, and often suffer psychological distress due to these experiences.

The burden of variability also weighs heavy on caregivers & loved ones

Those closest to the patient experience the ripple effects of the events described above. From managing and coping with the death of their loved one to providing assistance that also disrupts their daily lives and drains them of time, money, energy, and mental health, entire communities feel the impact of surgical variability.

The psychological impact of variability on surgeons

Generally speaking, surgeons and surgical staff strive to continuously hone their craft and deliver the best possible outcomes for their patients. But pervasive variability in processes and techniques (and especially the visibility issues that cause that problem) limits their ability to develop professionally — and to help others improve. The resulting complications and negative outcomes also take a psychological toll on them.

The financial, operational, and liability implications of variability on hospitals

The financial and operational impact on individual hospitals is tremendous. Estimated costs incurred due to gastric leak in laparoscopic sleeve gastrectomy are up to $10,000 per incident — and that’s just one complication that occurs in one type of procedure in one specialty. Hospitals also have to contend with liability issues, such as malpractice suits, insurance reimbursement, and more. And operationally speaking, even what may seem like minor efficiency issues, when replicated across thousands of procedures per year, can add up in terms of budget, resources, and patient care. In a system already stretched too thin, these institutions can ill afford the effects of surgical variability.

Health systems carry the consequences of variability at scale

Similar to how the impact on patients ripples outward to their communities, the impact on hospitals ripples throughout health systems, eating up precious resources that could be used to improve care. No one can “afford” to fix the problem, but the problem itself is costing an ever-growing fortune.

Surgical Variability: A problem we can’t afford to ignore.

Surgical variability has significant implications on the entire healthcare ecosystem, it’s clear that this is an issue we cannot afford to ignore. Though it’s unlikely that we can eliminate this issue entirely, there are steps we can take today to reduce avoidable procedural variability by driving standardization in adoption to evidence-based, surgical best practices. Only by capturing, structuring, and analyzing surgical data, we can surface intraoperative variability that impacts postoperative recovery and start to solve variability one department at a time. 

Ready to start reducing variability?

Download our Beginners Guide to Surgical Variability eBook:

The Role of Surgical Variability in Complication Prevention

The Frequency of Surgical Complications is Alarmingly High

From the earliest days of trepanation to modern minimally invasive techniques, we’ve come a long way in the field of surgery. But we’re still far from perfect. In fact, of the 300 million surgical procedures performed annually, nearly 1 in 6 still involve complications, resulting in around 3 million deaths per year. The subsequent physical, emotional, and psychological effects on patients and their loved ones, as well as the massive financial and operational impact on hospitals and surgical teams, are impossible to overstate.

The Role of Surgical Variability in Complication Prevention

Variability in surgical care contributes to this high incidence of preventable complications and poor outcomes,  and stems from a lack of adoption to data-driven surgical practices. And disparities aren’t limited to less-developed regions. We see variability between hospitals — and even departments — in major metropolitan centers of the most developed countries on Earth.

Administrators are painfully aware of this challenge, but have struggled to find any reliable way of solving it. Many hospitals invest heavily in hiring teams to analyze their own data and/or to participate in The American College of Surgeons National Surgical Quality Improvement Program (NSQIP). While the program is designed to measure and improve the quality of surgical care, participation does little more than confirm variability exists and show how participants measure up against their peer hospital groups. 

You don’t need sample data that’s delayed 6 months (and isn’t actionable) to tell you any of that. You need better ways to understand why this surgical variability exists in the first place, pinpoint specific areas of improvement, set goals, and achieve them. But let’s start with surgical variability: its causes, effects — and what hospitals and surgical teams can start doing about it now.

What causes surgical variability?

In its most literal sense, “surgical variability” means “not all surgeons perform surgery exactly the same way.” When we break down any procedure into its component steps (assuming even these are standardized), there are any number of different circumstances that could arise, techniques that could be employed, or processes that could be followed during each step that influences the outcome. 

For example, during a laparoscopic sleeve gastrectomy, oversewing the staple line has been shown to help prevent gastric leak and bleeding — two of the most serious complications of this common procedure. Yet a recent analysis of 370 sleeve gastrectomies revealed this technique was performed in only 60% of cases.*

The same analysis also revealed significant variability in surgical efficiency, with average time to perform a specific step, the gastric transection, as low as 13 minutes and 20 seconds for some surgeons, and nearly 39 minutes for others. Considering that longer procedure times are associated with poorer patient outcomes and higher hospital costs, this is no small matter.

While all these opportunities for deviation might seem to create an infinite number of un-trackable variations, there are some common threads that can help us make sense of it all:

  1. Healthcare inequity. Unfortunately, socioeconomic factors, inherent bias, and other equality-based considerations often cause disparities in care and outcomes. From limited access to even basic care (let alone advanced technologies) to communication and trust issues, myriad factors put a disproportionate share of the negative effects of surgical variability on historically marginalized populations.
  2. Patient factors. Every patient is different. Some have pre-existing conditions that put them at higher risk during certain procedures or specific techniques. Some have anatomical anomalies that require in-the-moment adjustments or deviations from standard practices. But particularly with common procedures that are performed thousands of times every day across the world, we should be able to account for these factors by now with documented surgical practices.
  3. Subjective experience. Due to the age-old apprenticeship model of surgical training, one surgeon’s career-long experience can be dramatically different from another’s without either ever realizing it. When your training and daily practice are so heavily guided by the subjective experience of one person (who learned many of the same things, the same way, from yet another single person, and so on), your perspective is inherently narrow and biased.
  4. Lack of actionable data. Although many aspects of surgery are tracked and reported, surgical teams often suffer from “DRIP” (data-rich, insight-poor) visibility issues. Sometimes there’s a scarcity of proof to back up new or emerging recommendations, making surgeons more hesitant to adopt them. And sometimes the data that could be most helpful is simply not reliable or accessible. For example, the best record most hospitals currently have of what goes on in the OR is the surgeon’s operative report. These are typically templatized, created after the fact, and (as has been widely reported) often highly inaccurate. In fact, one paper, entitled A Video is Worth a Thousand Operative Notes revealed that while operative reports claimed 85.1% of technical steps were followed, operative video confirmed only 52.5% actually had been.

Surgical Intelligence: The Next Step to Reducing Variability

Because of these factors, completely eliminating surgical variability may not be possible. But we have the resources to start reducing variability by a significant margin. Powered by AI and machine learning, Surgical Intelligence can help us connect the dots between patient characteristics, surgical practices, and post-op results. Because it’s understanding surgical outcomes is not enough, we have to understand how specific decisions and practices impact those outcomes. 

 

*References: Theator Surgical Intelligence Platform Data on File: Bariatric Procedure Analysis, 2023.

Dobson GP. Trauma of major surgery: A global problem that is not going away. Int J Surg. 2020 Sep;81:47-54. doi: 10.1016/j.ijsu.2020.07.017. Epub 2020 Jul 29. PMID: 32738546; PMCID: PMC7388795.

Ready to start reducing variability?

Download our Beginners Guide to Surgical Variability eBook:

 

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