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  • Remote video auditing with real-time feedback in an academic surgical suite improves safety and efficiency metrics: a cluster randomised study

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Original research
Remote video auditing with real-time feedback in an academic surgical suite improves safety and efficiency metrics: a cluster randomised study
  1. Frank J Overdyk1,
  2. Oonagh Dowling2,
  3. Sheldon Newman1,
  4. David Glatt1,
  5. Michelle Chester3,
  6. Donna Armellino4,
  7. Brandon Cole3,
  8. Gregg S Landis5,
  9. David Schoenfeld6,
  10. John F DiCapua1
  1. 1Department of Anesthesiology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
  2. 2Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
  3. 3Department of Anesthesiology, Long Island Jewish Medical Center, New Hyde Park, New York, USA
  4. 4Department of Anesthesiology, North Shore-LIJ Health System, Lake Success, New York, USA
  5. 5Department of Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
  6. 6Department of Biostatistics, Massachusetts General Hospital Biostatistics Center, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Frank J Overdyk, Department of Anesthesiology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, 270 76th Avenue, New Hyde Park, NY 11040, USA; overdykf{at}icloud.com

Abstract

Importance Compliance with the surgical safety checklist during operative procedures has been shown to reduce inhospital mortality and complications but proper execution by the surgical team remains elusive.

Objective We evaluated the impact of remote video auditing with real-time provider feedback on checklist compliance during sign-in, time-out and sign-out and case turnover times.

Design, setting Prospective, cluster randomised study in a 23-operating room (OR) suite.

Participants Surgeons, anaesthesia providers, nurses and support staff.

Exposure ORs were randomised to receive, or not receive, real-time feedback on safety checklist compliance and efficiency metrics via display boards and text messages, followed by a period during which all ORs received feedback.

Main outcome(s) and measure(s) Checklist compliance (Pass/Fail) during sign-in, time-out and sign-out demonstrated by (1) use of checklist, (2) team attentiveness, (3) required duration, (4) proper sequence and duration of case turnover times.

Results Sign-in, time-out and sign-out PASS rates increased from 25%, 16% and 32% during baseline phase (n=1886) to 64%, 84% and 68% for feedback ORs versus 40%, 77% and 51% for no-feedback ORs (p<0.004) during the intervention phase (n=2693). Pass rates were 91%, 95% and 84% during the all-feedback phase (n=2001). For scheduled cases (n=1406, 71%), feedback reduced mean turnover times by 14% (41.4 min vs 48.1 min, p<0.004), and the improvement was sustained during the all-feedback period. Feedback had no effect on turnover time for unscheduled cases (n=587, 29%).

Conclusions and relevance Our data indicate that remote video auditing with feedback improves surgical safety checklist compliance for all cases, and turnover time for scheduled cases, but not for unscheduled cases.

  • Healthcare quality improvement
  • Crew resource management
  • Surgery
  • Checklists
  • Anaesthesia

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjqs-2015-004226

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    Footnotes

    • Contributors FJO, OD and JFD contributed substantially to the conception and design of the work, the acquisition, analysis and interpretation of data, and the drafting of the manuscript. SBN, DG, MC, DA, BC and GSL contributed substantially to the acquisition, analysis and interpretation of data. DS contributed substantially to the design of the work, the analysis and interpretation of data, and the drafting of the manuscript.

    • Funding Arrowsight Inc.

    • Competing interests None declared.

    • Ethics approval North Shore LIJ Health System IRB.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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