The operating room is a high-risk, high-entropy environment, prone human error and preventable adverse events. Drawing on lessons from high-reliability organizations such as the aviation industry, the Aimbient Suite (formerly Operating Room Black Box) collects continuous, multimodal audiovisual and physiologic data capture to deepen our understanding of surgical safety. This platform has demonstrated an improvement in patient safety domains across several metrics including ground-truth benchmarking of checklist adherence, video-based multidisciplinary review conferences, and automated physiologic event tagging. Recent integration of key post-operative metrics of morbidity and mortality into the data streams collected by ambient monitoring platforms allows for us to achieve a holistic understanding of the perioperative record. As artificial intelligence capabilities rapidly expand and integrate into our healthcare system, ambient data capture is uniquely poised to generate real-time insights and break new frontiers in surgical patient safety.