What’s New in the Patient Safety World
January 2016
Video Recording
One underutilized patient safety tool that we have recommended for the
past decade – video recording – is finally starting to get attention in the
literature. Two recent articles have noted some of the potential benefits of
video recording in healthcare settings.
First was an editorial in the British Medical Journal (Makary 2015). Makary and colleagues use the analogy of video recording in
the OR to that of the “black boxes” in airplanes. They can be used
retrospectively to review what actually happened in cases with unwanted
outcomes rather than relying simply on the recollection of all involved. But
they also note the potential of the “Hawthorne effect” to lead to improvements.
They also note that “if concerns about consent, privacy, and data security are
dealt with carefully, video data can tell a story that simply cannot be matched
by written documentation.”
Makary has written previously about the benefits
of video recording (Makary 2013).
He noted that North Shore University Hospital was able to improve hand washing
compliance from 6.5% to 81.6% after installing cameras to monitor hand washing
(see our March 2012 What's New in the Patient Safety
World column “Smile...You’re
on Candid Camera!”). He also noted that many procedures are already being
recorded, noting that colonoscopy performance measures improved considerably
once physicians became aware that someone might review the videos of their
procedures. He also describes how reviewing videos of procedures can be used in
a “coaching” manner to improve performance, similar to a coach reviewing play
with players after an athletic contest. Importantly, as we have often
discussed, video recording is also a good way to identify and deal with disruptive
behavior and other behaviors that interfere with good teamwork. And he also
notes that patients generally like the idea of having their procedures
recorded, even receiving a copy of some of these videos.
In a series of
letters commenting on his 2013 editorial, issues of legal protection and
patient privacy were raised (Kels 2013,
van der
Veldt 2013). Makary’s reply (Makary 2013b)
was that improving patient satisfaction by providing video recording may well
reduce the threat of malpractice suits and that the patient privacy issues can
be dealt with by informed consent and securing the video as securely as the
medical record is secured.
The other recent
publication was a controlled trial of video monitoring in the OR with real-time
feedback (Overdyk
2015). It demonstrated that compliance with the surgical safety
checklist improved significantly in those OR’s receiving real-time feedback. In
addition, OR efficiency improved in that mean turnover times for scheduled
cases was reduced by 14% in the OR’s receiving real-time feedback. The video
streams were audited by a 10-person audit team to identify and time OR
milestones to the nearest 20 seconds. Real-time feedback metrics were posted to
OR display boards or sent as email or text alerts to the OR team. An example of
an alert might be “time out failed”, which allowed surgeons, anesthesia
providers and nurse managers to intervene.
The Overdyk study goes way beyond what we had envisioned in the
utility of video monitoring. While virtually all of our recommendations
involved retrospective review of activities recorded, the Overdyk
study demonstrates the potential power of using this modality in real-time.
That is really exciting! The Overdyk study does
include any data on the costs of the system, which appear to be moderate.
However, the improved OR efficiencies and the potential savings from prevention
of errors may well cover the cost of such extensive systems.
Overdyk and colleagues also discuss how they were
able to overcome the two most common barriers to use of video recording: (1)
concerns about legal “discoverability” and (2) patient privacy issues. Their
study was also designed to measure team performance rather than individual
performance and was done in a non-punitive fashion. The researchers felt this
was a significant factor in acceptance of use of the technology by the staff.
The Overdyk study utilized only video feeds and did not include
audio recording. For most of the uses for which we have recommended recording
the audio portion is at least as important (and often more important) than the
video portion.
We’ve, of course, advocated for various uses of video recording over
the past decade. Constructive review of recorded OR sessions is a great way to
enhance teamwork and communication in the OR. Also, in our September 23, 2008 Patient Safety Tip of the Week “Checklists
and Wrong Site Surgery” we advocated use of video recording as a way to
improve compliance with Universal Protocol, the WHO Surgical Safety Checklist,
and other OR activities.
In our March 17,
2015 Patient Safety Tip of the Week “Distractions
in the OR” we noted that video recordings could be used to identify
distractions in the OR. And in our November 24, 2015 Patient Safety Tip of the Week
“Door
Opening and Foot Traffic in the OR” we noted that review of video recordings
might also be a useful way to determine the reasons for door opening in the OR
in attempt to identify and reduce unnecessary door openings and unnecessary
foot traffic.
And video recording
is not just for the OR. In our November 2011 What's
New in the Patient Safety World column “Restricted
Housestaff Work Hours and Patient Handoffs” we
noted that recording of handoffs is a potential way to improve the quality of
handoffs. We noted in that column that doing video/audio recording is
preferable to just audio recording since so much of such interactions involve
non-verbal behavior. We’ve already noted how video recording can be used to
improve hand hygiene compliance. It could also be used to constructively help housestaff perform bedside procedures.
We concur with Makary et al. that the time
has come to make better use of video recording technology. And that study by Overdyk et al. takes this technology tool to a whole new
level.
Some of our
previous columns discussing video recording:
September 23, 2008
“Checklists
and Wrong Site Surgery”
December 6, 2010 “More
Tips to Prevent Wrong-Site Surgery”
November 2011 “Restricted
Housestaff Work Hours and Patient Handoffs”
March 2012 “Smile...You’re
on Candid Camera!”
August 27, 2013 “Lessons
on Wrong-Site Surgery”
March 17, 2015 “Distractions
in the OR”
November 24, 2015 “Door
Opening and Foot Traffic in the OR”
References:
Overdyk FJ, Dowling O, Newman S, et al. Remote
video auditing with real-time feedback in an academic surgical suite improves
safety and efficiency metrics: a cluster randomised
study. BMJ Qual Saf 2015;
Published Online First 11 December 2015
http://qualitysafety.bmj.com/content/early/2015/12/11/bmjqs-2015-004226.short?g=w_qs_ahead_tab
Makary MA, Xu T, Pawlik
TM. Can video recording revolutionise medical
quality? BMJ 2015; 351 (Published 21 October 2015)
http://www.bmj.com/content/351/bmj.h5169
Makary MA. The power of video recording: taking
quality to the next level. JAMA 2013; 309(15): 1591-1592
http://jama.jamanetwork.com/article.aspx?articleid=1673991
Kels CG. Video Recording of Medical Procedures.
JAMA. 2013; 310(9): 979-980
http://jama.jamanetwork.com/article.aspx?articleid=1734690
van der Veldt AAM, Kleijn SA, Nanayakkara PW. Video Recording of Medical Procedures.
JAMA. 2013; 310(9): 979-980
http://jama.jamanetwork.com/article.aspx?articleid=1734690
Makary M. In reply: video recording of medical
procedures. JAMA 2013; 310(9): 979-980
http://jama.jamanetwork.com/article.aspx?articleid=1734690
Print “PDF
version”
http://www.patientsafetysolutions.com/