As hospitals strive to improve patient safety and quality of medical care, they should consider widespread use of video recording systems already in place to document procedures, to use as a teaching tool and to figure out what's going right or wrong.
In a commentary published online ahead of print in the April 17 issue of the Journal of the American Medical Association, surgeon and patient safety expert Martin Makary argues that such use of video recordings would benefit patients and physicians alike.
"We are not talking about rewiring hospitals and installing new cameras, as much of what we do in the hospital today is already video-based," says Makary, an associate professor of surgery at the Johns Hopkins School of Medicine. "Procedures ranging from cardiac stent placement to arthroscopic surgery are already being performed using equipment outfitted with cameras, but the record button is often turned off. The potential to harness the data in these videos and drive quality improvement is tremendous."
Makary says that use of video technology has already been shown to improve hand-washing rates and the quality of colonoscopies, and could even cut medical waste by exposing unnecessary procedures.
The technology, he says, has already been used in some hospitals to record procedures for later review by senior physician-coaches as a teaching tool. Videos can better inform efforts to determine what went wrong if a patient is injured or dies, he says. And a video of a procedure could be made part of the electronic medical record to inform a future surgeon, as the information is more detailed than a clinician's notes.
Makary says research suggests that patients appear to support the idea of having their procedures recorded. In one example he writes about, 248 patients were asked if they would be interested in receiving a video of their procedure: 81 percent said yes, and 61 percent were willing to pay for it.
"Sharing videos with patients may improve their satisfaction because it embodies a broader spirit of medical transparency," he says.
In his essay, Makary also cites a coaching program at one hospital where surgeons spent an hour reviewing procedure videos with an expert. Such video-based peer review informed surgeons about alternative approaches to problems they encountered during operations and how they could be more efficient. The reviewer also suggested ways to better position the patient, surgical assistants, and the surgeon, as well as surgical retractors, for optimal exposure. He says that video-based quality-improvement initiatives could be offered remotely and draw on the expertise of collaborations among multiple institutions.