Faculty Zucker School of Medicine

Clinical Study in BMJ Quality & Safety Finds Remote Video Auditing with Real-Time Feedback Dramatically Improves Patient Safety and Efficiencies in the Operating Room

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DiCapuaStudy author, John Di Capua, MD

GREAT NECK, NY–A study published on December 11 in BMJ Quality & Safety indicates that when used in operating rooms, third-party remote video auditing (RVA) with real-time feedback has the ability to improve a surgical team’s compliance with surgical safety checklists for all cases and turnover time for scheduled cases.

The cluster randomized study was conducted in a 23-room operating suite at Long Island Jewish Medical Center in New Hyde Park, NY, part of the North Shore-LIJ Health System, using Arrowsight’s remote video auditing technology. The study, conducted from August 1, 2013 to April 18, 2014, evaluated the impact of RVA with real-time provider feedback on surgical safety checklist compliance during sign-in, time-out and sign-out and case turnover times. Participants included surgeons, anesthesia providers, nurses and support staff. Operating rooms (ORs) were randomized to receive or not receive real-time feedback on surgical safety checklist compliance and efficiency metrics via display boards and text messages followed by a period where all 23 ORs received feedback.

Although compliance with the surgical safety checklist during operative procedures has been shown to reduce in-hospital mortality and complications, proper execution by the surgical team remains elusive. As described in today’s BMJ Quality and Safety publication, by using RVA, sign-in, time-out and sign-out compliance rates increased from 25 percent, 16 percent and 32 percent during baseline phase to 91 percent, 95 percent and 84 percent for ORs during the all-feedback phase. In addition to driving significant patient safety improvements, RVA improved turnover times in between cases (i.e. efficiencies) by 14 percent for all scheduled cases and 20 percent for “fast” scheduled cases.nsLIJ

“Beginning in 2008, North Shore-LIJ became the nation’s first health care provider to use video monitoring as part of our efforts to strengthen patient safety,” said Michael Dowling,president and chief executive officer at North Shore-LIJ. “We are very pleased to be recognized by world-class medical journal, BMJ Quality and Safety, for using RVA to drive significant improvements in patient safety and efficiencies in the OR.”

North Shore-LIJ Health System first used RVA by installing cameras in its medical and surgical ICUs to monitor for hand hygiene compliance. In a 2011 study published in Clinical Infectious Diseases, the hospital demonstrated that the use of Arrowsight’s third-party RVA system rapidly improved and sustained hand hygiene rates to nearly 90 percent in less than four weeks. In 2013, there was a prominent recognition of this ground breaking study in a JAMA editorial entitled The Power of Video Recording Taking Quality to the Next Level.

“This study validates RVA technology as being able to significantly impact both surgical safety checklist compliance and OR efficiencies. It also demonstrates the importance of effective teamwork on improving patient safety,” said John Di Capua, MD, (photo above) study author, chair and associate professor of anesthesiology at the Hofstra North Shore-LIJ School of Medicine and CEO of North American Partners in Anesthesia (NAPA).

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Zachary Hanby

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