Video capture of clinical care to enhance patient safety
- Anesthesia Ergonomics Research Laboratory of the San Diego Center for Patient Safety, Veterans Affairs San Diego Healthcare System, and the Department of Anesthesiology, University of California, San Diego, USA
- Correspondence to: Professor M B Weinger San Diego Center for Patient Safety, VA San Diego Medical Center (125A), 3350 La Jolla Village Drive, San Diego, CA 92161-5008, USA; mweingerucsd.edu
- Accepted 1 October 2003
Abstract
Experience from other domains suggests that videotaping and analyzing actual clinical care can provide valuable insights for enhancing patient safety through improvements in the process of care. Methods are described for the videotaping and analysis of clinical care using a high quality portable multi-angle digital video system that enables simultaneous capture of vital signs and time code synchronization of all data streams. An observer can conduct clinician performance assessment (such as workload measurements or behavioral task analysis) either in real time (during videotaping) or while viewing previously recorded videotapes. Supplemental data are synchronized with the video record and stored electronically in a hierarchical database. The video records are transferred to DVD, resulting in a small, cheap, and accessible archive. A number of technical and logistical issues are discussed, including consent of patients and clinicians, maintaining subject privacy and confidentiality, and data security. Using anesthesiology as a test environment, over 270 clinical cases (872 hours) have been successfully videotaped and processed using the system.
Footnotes
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↵* If you have an average 90% participation rate and the average size of the clinical team to be studied is 8, you have a 43% chance of getting all clinicians to consent to participate ((0.9)8).
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↵† Federal regulations governing informed consent (CFR §46.116(d)) clearly provide for a waiver of consent when: (1) the research involves no more than minimal risk to the subjects; (2) the waiver or alteration will not adversely affect the rights and welfare of the subjects; (3) the research could not practicably be carried out without the waiver or alteration; and (4) whenever appropriate, the subjects will be provided with additional pertinent information after participation.
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↵* “Section 1157 represents a legislative choice between competing public concerns. It embraces the goal of medical staff candor at the cost of impairing plaintiffs’ access to evidence.” (Matchett v Superior Court (1974), 40 Cal.App3d 623, 628–629).
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↵† Memorandum by Susan Greene Merewitz, Senior Attorney for the Agency for Healthcare Research and Quality (AHRQ), 16 April 2001. Available at: http://www.ahrq.gov/fund/datamemo.htm.
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This work was supported by grants to Dr Weinger from the Department of Veterans Affairs (HSR&D IIR 20-066) and the Agency for Healthcare Research and Quality (R01-HS11375 and P20-HS11521).
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Presented at the Video as Research Data Conference, Baltimore, Maryland, 30 September 2002, sponsored by the Agency for Healthcare Research and Quality.
