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Randomized Controlled Trial
. 2016 Dec;25(12):947-953.
doi: 10.1136/bmjqs-2015-004226. Epub 2015 Dec 11.

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

Frank J Overdyk  1 , Oonagh Dowling  2 , Sheldon Newman  1 , David Glatt  1 , Michelle Chester  3 , Donna Armellino  4 , Brandon Cole  3 , Gregg S Landis  5 , David Schoenfeld  6 , John F DiCapua  1
Affiliations
Randomized Controlled Trial

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

Frank J Overdyk et al. BMJ Qual Saf. 2016 Dec.

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 outcomes and measures: 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.

Keywords: Anaesthesia; Checklists; Crew resource management; Healthcare quality improvement; Surgery.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Wide-angle camera displaying blurred image of operating room and use of yellow surgical safety checklist.
Figure 2
Figure 2
OR ‘Status’ display board during all-feedback phase of study. OR, operating room.
Figure 3
Figure 3
OR safety and efficiency metric display board during intervention phase. BL, baseline; T, target time in minutes; PS, patient safety; OR, operating room.
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