In medicine, the problems of wide variations in quality and poor compliance with evidence-based care are well known. More education is not the solution for these problems. Knowledge is abundant, but implementation of knowledge often lags. This Viewpoint explores whether use of an existing technology, video recording of medical procedures, can improve quality of care.
Although the World Health Organization’s hand washing declaration and aggressive global awareness campaign has been long established, behavior change among health care workers remains a persistent struggle. For instance, at Long Island’s North Shore University Hospital, hand washing compliance rates were consistently low despite educational efforts. In response to these low rates, the hospital took an assertive approach to solving the problem by installing cameras to monitor hand washing rates. The outcome data were reported to the staff and as a result, compliance increased from 6.5% to 81.6%,1 demonstrating the potential power of this technology in the medical setting.
The concept of measuring quality for learning is not a proposal to rewire hospitals and install cameras, but rather, a consideration that many applicable activities and procedures are already video based. For example, procedures ranging from cardiac stent placement to arthroscopic surgery are performed using sophisticated video equipment; however, the record button is often turned off. The potential to harness the data in these videos and drive quality improvement may be substantial.
At Indiana University, Rex et al2 decided to use the recording feature of colonoscopy video equipment to address the long-standing problem of quality variations in colonoscopies. Over several months, the investigators performed a blinded review of 98 colonoscopy videos performed by 7 gastroenterologists who were unaware that their procedures were being recorded. Procedure quality scores and mucosal inspection time data were collected based on established criteria. Wide variations in quality were found. The researchers then informed the gastroenterologists that their procedures were being video recorded and peer reviewed. Following the announcement, mean inspection time during colonoscopy increased by 49% and quality of mucosal inspection improved by 31%,2 suggesting a substantial improvement in quality because of the Hawthorne effect.
Peer review of videos can also enhance existing quality improvement efforts. For example, procedure videos can better inform morbidity and mortality conferences and sentinel event root-cause analyses that have traditionally relied on the notes of clinicians, which can be limited and even biased. Moreover, the exportability of video files can facilitate external review, allowing a peer reviewer removed from a local department’s politics to advise on what could have improved.