A. H. Bui1, S. Guerrier1, D. L. Feldman1,2, P. Kischak2, S. Mudiraj2, D. Somerville2, M. Shebeen1, C. Girdusky1, I. Leitman1 2Hospitals Insurance Company,New York, NY, USA 1Mount Sinai School Of Medicine,Surgery,New York, NY, USA
Introduction: Teamwork in the operating room is necessary for avoiding preventable errors that can lead to patient injury and even death. Direct and indirect observation methods in the OR such as the use of live observers or video cameras allow for the evaluation of surgical performance and compliance with best-practice guidelines. They also allow for provision of either immediate or delayed feedback to the surgical team. However, little is known about how these methods compare to each other in improving OR teamwork. This study examines the relative effectiveness of video and live observation.
Methods: As part of a patient safety quality improvement initiative, video and audio cameras were installed in 2014 to record all activities within the ORs of an 875 bed urban hospital. Recordings were chosen at random for review by an internal quality improvement team. Concurrently, live observers were deployed into a random selection of operations. A customized, validated tool was used to evaluate time-outs (briefs) and sign-out (debriefs) by the OR team, serving as a proxy measure of compliance with TeamSTEPPS skills. Feedback was given to OR teams either in real-time during live observation or in writing following review of the video recording. Fisher’s exact tests were used to compare compliance with these skills under live vs. video observation.
Results: A total of 1,410 time-outs were evaluated: 325 (23%) through live observation, 1,085 (77%) through video. A total of 1,398 debriefs were evaluated: 166 (12%) live and 1,232 (88%) video. For briefs, greater compliance was observed under live observation compared to video for recognition of team membership (87% vs. 44%, p<0.001), anticipation of complex procedural events (61% vs. 45%, p<0.001), and resource monitoring (58% vs. 42%, p<0.001). For debriefs, greater compliance was observed under live observation for determination of team structure (90% vs. 60%, p<0.001) establishment of a leader (70% vs. 51%, p<0.001), discussion of postoperative plan (77% vs. 48%, p<0.001), what went well and what needs improvement (49% vs. 33%, p<0.001), engagement of all team members (64% vs. 41%, p<0.001), and check back (61% vs. 46%, p<0.001) compared to video. More barriers to compliance were noted in video compared to live observation for briefs (p<0.001) and debriefs (p=0.004).
Conclusion: Video may not be as effective as live observation in promoting OR communication and teamwork. The role of live, video, and other forms of external feedback in improving OR team performance and patient outcomes needs to be further evaluated. Live observations enable immediate feedback, which may improve behavior and reduce barriers to full compliance with surgical safety practices.
