Public Release: 

Medical procedures should be recorded to improve quality and accountability, say experts

BMJ

Professors Martin Makary and Timothy Pawlik at Johns Hopkins University School of Medicine in Baltimore say that as well as detecting unprofessional behaviour, video recording has the potential to radically improve quality through increased accountability, and can be used for learning and self improvement.

If concerns about consent, privacy, and data security are dealt with carefully, "video data can tell a story that simply cannot be matched by written documentation," they write.

They point to other areas where cameras have successfully changed behaviour. For example, whereas decades of education failed to increase compliance with speed limits, speed cameras have decreased the proportion of speeding vehicles by up to 65% in some countries and reduced crashes by up to 49%.

In medicine, video recording has the potential to eliminate unnecessary procedures, reducing both preventable harm and wasteful spending, they say. For many challenging operations, surgeons could also benefit from watching archived video in preparation either to re-operate or to do a similar operation.

Learning from preventable events can be enhanced by video recordings, they add. "Instead of basing incident reviews on the recollection of the people involved, videos could be used to determine the clinician, patient, and system factors that had a role in an event and the relative contributions of each."

Research also shows the power of videotaping for quality improvement. In one study, doctors performing bowel examinations improved after being told that their procedures were being recorded and peer reviewed. And a hand hygiene project increased hand washing from 6.5% to 81.6% after a hospital installed cameras to monitor compliance.

Patients also like the idea of having their procedure recorded. In a survey of 248 patients, 81% expressed interest in having their procedure videotaped and 61% of patients said they were willing to pay for it.

Makary and Pawlik suggest that offering patients a copy of their procedure on video "not only creates a detailed record but may also instil trust through the increased transparency."

"In an era where 86% of nurses report having recently witnessed disruptive behaviour at work, hand washing compliance remains highly variable, and many physicians do not use evidence based medicine, recorded video can be an invaluable quality improvement tool," they conclude.

"Devices used for many medical and surgical procedures now have a record button. It's time that we turned it on."

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