Remote video auditing: 5 applications to improve patient safety, efficiency

Just as sports teams watch game film to analyze performance and identify opportunities for improvement, remote video auditing in the healthcare setting gives clinicians the opportunity to receive near real-time performance feedback to help them improve care and reduce the possibility of adverse events.

 

"About 15 years ago, I had a moment where I said to myself, why don't businesses use video the way that sports teams [do]?" Adam Aronson, CEO of Arrowsight, said during a March 23 webinar hosted by Becker's Hospital Review. "So we decided to explore that and really create a whole business around a pretty simple concept of putting video cameras into the workplace and looking in on areas of high risk or high opportunities for productivity improvements."

What is RVA?

With RVA, people in a remote, third-party Network Operations Center observe hospital staff performance via video, annotate that video footage using special software, create data around it and give near real-time feedback to staff and supervisors, Mr. Aronson explained. Data is automatically streamed back to organizations via plasma screens and mobile devices, and texts and email alerts can be sent to specific staff members.

"The goal of it is to replicate the performance of the staff as if a front-line manager was present at all times," he explained.

The feedback is used in a non-punitive fashion to identify areas ripe for improvement and reward great work.

"It's all … about positive reinforcement and really the use of this technology as a way to measure excellence versus what your instincts might be which is, oh, this is a 'big brother' concept," Mr. Aronson said.

Arrowsight initially targeted the food industry in 2004. RVA helped reduce E. coli rates by 60 percent for the largest meat company in the world, among other successes and improvements. Arrowsight RVA services are used in factories that produce more than half of U.S. meat products.

Mr. Aronson turned his sights to healthcare in the late 2000s after his mother and sister both developed preventable infections during separate hospital stays. Since then, several surgery centers and hospitals have been able to decrease infection rates and increase patient safety and operating room efficiency using RVA technology.

See how one hospital lowered surgical site infection rates and reduced OR turnover times using RVA technology.

Here are five areas of healthcare in which RVA technology has proven successful.

1. Hand hygiene

Northwell Health in New Hyde Park, N.Y., was an early adaptor of RVA technology. It installed cameras in a 17-bed medical intensive care unit in North Shore University Hospital in Manhasset, N.Y., to measure and improve hand hygiene compliance rates.

At the start of the 2.5-year-long study, hand hygiene compliance was below 10 percent. After implementing RVA technology and using near-real-time feedback, hand hygiene compliance improved to roughly 90 percent in just four weeks, and those rates were sustained for years. The hospital's results were published in 2011 in the journal Clinical Infectious Diseases.

In 2013, Martin Makary, MD, with Johns Hopkins in Baltimore, wrote a viewpoint article in JAMA about the power of RVA, which helped the technology get a foothold into the healthcare industry and expand its use to other areas of hospitals.

2. OR patient safety and perioperative efficiency

After finding success in raising hand hygiene compliance rates at North Shore University Hospital with RVA, Northwell Health started using RVA in the surgery departments at both their Forest Hills Hospital and Long Island Jewish Medical Center's operating rooms in 2013.

LIJ Medical Center leaders chose actions for Arrowsight to audit via video with the goal of improving patient safety as well as efficiency in the OR, according to Sheldon Newman, MD, the executive vice chairman of anesthesia. "The main driver behind this really for us was patient safety," Dr. Newman said. "That was the No. 1 thing we wanted to [achieve]."

Therefore, the hospital chose to measure compliance with sign-in, time-out and sign-out compliance, as well as terminal cleaning compliance.

Beyond patient safety, LIJ Medical Center also chose to use RVA to improve efficiency, with auditors looking for patient exit to cleaning start, cleaning start to cleaning stop, cleaning stop to room sterile and room sterile to next patient in room. "What we're looking at is not asking people to run faster, it's looking at improving process so that we can be more productive and actually ask people not to run as fast," Dr. Newman said.

The hospital's compliance with those metrics is openly displayed in near-real time — although there is a delay of roughly five minutes, Dr. Newman said. Status boards show the status of each operating room — if a room is clean, if a patient is in a room but the case hasn't started, and if a case is in progress, for instance.

In addition to status boards, LIJ Medical Center also uses feedback boards, showing aggregate compliance data for all ORs and data on each individual OR. It displays turnover time and compliance with sign-in, time-out and sign-out.

Dr. Newman noted the importance of aggregating data and not singling out individual clinicians. "It's not about the anesthesiologist in the room, or the surgeon in the room, or the nurse in the room, this is all about the team," he said. "It has done an incredible job to build camaraderie and collegiality and frankly eliminate the finger pointing and the blame."

In addition to the status and feedback boards, Arrowsight can send text messages to certain groups of people to expedite patient flow. For instance, an anesthesiologist can get a text when his or her OR is sterile, the surgeon can get a text when his or her patient is in the room, and so forth.

After implementing RVA technology and feedback boards, LIJ Medical Center published its results in BMJ Quality & Safety in 2015, including the following:

No wrong-site surgeries or retained foreign objects since RVA inception

A 14 percent decrease in turnover times in one year

Improved compliance with sign-in, time-out and sign-out procedures in under a month after feedback started

3. Terminal and in-between case cleanings

Arrowsight can work with hospitals' infection control teams to understand the exact protocol they want environmental services to follow during terminal cleans and audit compliance via video. Mr. Aronson said this led to "swift and rapid improvement to terminal cleaning compliance" at LIJ Forest Hills (N.Y) Hospital, part of Northwell Health.

Arrowsight can help hospitals improve in-between case cleanings in the OR as well. UPMC Hamot in Erie, Pa., measured not only OR safety and efficiency, but also in-between case cleanings. According to a study in AORN Journal, UPMC Hamot improved compliance with in-between case cleaning from 79 percent to 93 percent after feedback was given, and compliance with terminal cleaning from 67 percent to 94 percent in about a month after feedback, and rates were sustained for at least a year.

The hospital linked this increased compliance to a 20 percent decrease in surgical site infections. This is a very significant achievement that not only improves patient safety — but also provides a substantial savings for the hospital due to the reduction of these very costly infections.

According to Mr. Aronson, hospitals don't need to install permanent cameras in the OR to audit OR cleaning — cleaning crews can set up portable cameras while they're in the room and Arrowsight can audit the footage after the fact. "This is a much lighter, easier first step for hospitals," he said.

4. PPE compliance and patient flow

LIJ Medical Center was so impressed with the safety and efficiency gains it achieved using RVA in the operating room, "we couldn't help but ask the question, 'Where else could this be utilized and how else can we utilize this?'" said Michael Goldberg, executive director of LIJ Medical Center.

In that vein, LIJ Medical Center installed 88 cameras in hallways throughout the hospital to watch the process of how people don (put on) and doff (take off) personal protective equipment and dispose of it in rooms of people with contact precautions.

"If we flag a room that is a contact precaution room, Arrowsight can flag that room and for every person that enters it and leaves it, and make sure they put on their proper PPE. Then we can design and provide real-time feedback to the people on the unit to make sure we are reducing the potential for spreading infections around the hospital," Mr. Goldberg said.

The hallway cameras can also help streamline patient flow through text alerts that indicate when rooms are open and available.

5. Scope reprocessing

LIJ Medical Center also expanded use of RVA into its endoscopy suite to audit scope cleaning. High-resolution cameras are used to make sure staff follow manufacturers' scope-cleaning guidelines to a T.

"We can utilize the cameras to make sure the very complex process of cleaning scopes safely and efficiently is followed," Mr. Goldberg explained.

East Side Endoscopy in Manhattan, an affiliate of New York City-based Mount Sinai Health System, uses RVA to track its scope-cleaning compliance and efficiency. After just two months of feedback, compliance increased from around 70 percent up to the mid-90s, Mr. Aronson said.

To view a recording of the webinar, click here.

Click here to download the webinar's slides.

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