Feb 21, 2016
Dec 12, 2016
A current review published in the British Medical Journal of Quality and Safety (1) describes new applications of this existing technology creating a revolution in both patient safety and enhancing operational efficiency, Remote Video Assessment, (RVA ℠). What is even more impressive is that it not only pays for itself, it provides a return on investment. The best ideas often use existing tools for a new application and RVA ℠ is just that. By using RVA ℠oversight, health care executives, patient safety professionals, risk managers, process improvement experts as well as system and operations managers enhance performance and create a data repository rich with opportunities for improving service and outcomes.
Ground breaking research has reported real opportunities for improving performance and saving money with video oversight in the health care industry. A recent study used video recording in the operating room (OR). The goal was to see the impact on start times, turn around times, compliance with timeouts, use of checklists and attentiveness. The data demonstrated video use both increases patient safety and enhances efficiency. The study design allowed real time feedback to OR personnel. By placing monitors in the hallways as well as nursing, surgical and anesthesia lounges, OR status and OR team efficiency metrics were communicated. In addition OR, staff and surgeons received text alerts on their smart phones and by email on OR status changes and safety alerts. Messages such as ‘next patient in OR’, ‘drape down’, ‘time out failed’ or ‘team distracted’ were communicated.
Successful outcomes included increased time out compliance, increased sign in and sign out compliance, and very importantly a 14% decrease in turnover time. Based on the improved efficiency and likely substantial ROI, the hospital decided to continue video oversight beyond the study period.
The use of video monitoring for jobs involving public safety is well-established. The airline industry has used the black box ( without video) as a tool for safety and retrospective analysis of adverse events for decades. In addition many other industries use video surveillance for monitoring quality and safety analysis. The transportation industry has a long history of providing video monitoring of both the operators of trains and motor vehicles. Cameras directed at operators and the surrounding environments are used.
The effectiveness of RVA ℠ for changing behavior has been established. The beneficial results of RVA ℠ are likely due to some combination of Sentinel effect, Hawthorne effect and peer pressure. The current public request for body cameras for law enforcement personnel is also based on the desire to improve performance and provide accountability.
One of the initial concerns of implementing RVA ℠ is legal. Privacy and liability issues are raised. There are many straightforward strategies to address these issues including obtaining consent in advance, technically altering images to de-identify individuals and adopting policies and procedures which insure statutory and regulatory compliance. With appropriate counsel, the legal concerns when implementing RVA ℠ have been effectively mitigated.
At institutions where there is a robust culture of safety encouraging transparency and open communication, RVA ℠ should be embraced as a welcome tool for improvement. Sentinel events and near misses are accessible to review. Where there is a culture of blame, retribution, poor communication or punitive consequences RVA ℠ must be introduced incrementally and its use will then improve the culture.
The exciting results of the research described above are that not only was patient safety enhanced but efficiency was improved. Based on increased efficiency there is a significant return on investment which provides the financial vehicle to support RVA ℠. The ability to perform retrospective review of maloccurrences and near misses is extremely promising with objective evidence of the events that took place rather than relying on just memory. Furthermore the opportunity to identify the practice patterns of those with the greatest efficiency and strong safety profiles can be used to establish best practices. The video data obtained can be used for training. RVA ℠ can also be used for credentialing (OPPE and FPPE ).
The applications of RVA ℠ are protean. Use in the outpatient setting for assessment of performance by clinical providers would likely improve diagnostic workup. Other settings for RVA ℠ such as patient registration, patient intake, nursing interaction, discharge planning and communication are promising. RVA ℠ of the dispensing and administration of drugs could be used as a safety and peer review tool. Video oversight will revolutionize health care delivery by improving performance, enhancing safety and efficiency. Further applications such as for root cause analysis, identifying best practices, training and data collection for process improvement are equally exciting.
Copyright, Nicolas Argy, 2016