Video recording of cardiac arrest management: an aid to training and audit
Abstract
A video camera and microphone are used to record the management of cardiac arrests in the accident and emergency department. The recordings provide a useful tool for training and audit.
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Cited by (20)
The impact of video recording colonoscopy on adenoma detection rates
2012, Gastrointestinal EndoscopyCitation Excerpt :The main advantage of video recording would be the creation of a permanent record that can be used or analyzed at a later time, and, hence, it would increase accountability and bring colonoscopy documentation to the standard of radiographic studies. Many authors have described video recording of clinical care, primarily for purposes of clinical education and research.17-21 Studies evaluating the use of video recording to improve performance or to enhance quality are limited.
The adenoma detection rate (ADR) is a quality benchmark for colonoscopy, influenced by several factors including bowel preparation, withdrawal time, and withdrawal technique.
To assess the impact of video recording of all colonoscopies on the ADR.
Comparison of two cohorts of patients undergoing colonoscopy before and after implementation of video recording.
Academic outpatient endoscopy facility.
This study involved asymptomatic, average-risk adults undergoing screening colonoscopy.
Video recording of all colonoscopy procedures. Polyp findings and withdrawal times were recorded for 208 consecutive screening colonoscopies. A policy of video recording all colonoscopies was implemented and announced to the staff. Data on another 213 screening colonoscopies were subsequently collected.
Adenoma detection rate, withdrawal time, advanced polyp detection rate, hyperplastic polyp detection rate.
At least one adenoma was found in 38.5% of patients after video recording versus 33.7% before video recording (P = .31). There was a significant increase in the hyperplastic polyp detection rate (44.1% vs 34.6%; P = .046). Most endoscopists had a numerical increase in their ADRs, but only one was significant (57.7% vs 22.6%; P < .01). There were trends toward higher detection of adenomas of <5 mm (59.1% vs 52%; P = .23) and right-sided adenomas (40.2% vs 30.4%; P = .11) in the video recorded group.
No randomization, confounding of intervention effects, and sample size limitations.
Video recording of colonoscopies is associated with a nonsignificant increase in the ADR and a significant increase in the hyperplastic polyp detection rate. There may be a benefit of video recording for endoscopists with low ADRs.
Video recording of newborn resuscitation in delivery room: Technique and advantages
2011, Archives de PediatrieL’extrême fragilité des nouveau-nés de moins de 28 SA (semaine d’aménorrhée) nous impose une vigilance extrême notamment dans les toutes premières minutes de vie, en salle de naissance. Cette période où le nouveau-né nécessite des gestes de réanimation est très probablement un moment crucial pour son pronostic ultérieur. Chaque geste est déterminant et doit être effectué avec précision, rapidité en limitant toute iatrogénie malgré le stress de l’équipe soignante. Afin d’évaluer de façon objective nos pratiques en salle de naissance chez les prématurés de moins de 28 SA et de nous assurer qu’elles rejoignent le plus possible les recommandations internationales, nous avons équipé en 2007 notre salle de naissance d’une caméra Mobotix à double objectif grand angle. Ce projet a rapidement obtenu l’adhésion de toute l’équipe soignante. Dans la mesure où ces enregistrements sont anonymisés, confidentiels et utilisés dans le cadre d’un audit des bonnes pratiques, notre comité éthique local n’a pas préconisé de rechercher un consentement parental. Les séquences analysées au cours de séances de debriefing, nous ont permis de mettre en évidence un certain nombre d’erreurs et de mettre en place les actions correctives adéquates. Parmi celles-ci, on retrouve fréquemment des erreurs d’hygiène, un retard d’adaptation des paramètres de ventilation, et des difficultés de ventilation au masque avec obstruction des voies aériennes supérieures. Cette technique nous a également permis d’évaluer la qualité des interventions et de la coordination de l’équipe. C’est aussi un excellent outil d’enseignement auprès des médecins en formation et des sages femmes.
An extreme attentiveness is mandatory when caring about extremely-low-gestational-age neonates at birth because of their innate vulnerability. The interventions performed during resuscitation of these infants may have direct influence on the immediate survival and also on long-term morbidity. Although stressfull, each resuscitation step is crucial and needs to be precise, fast and harmless. In order to determine our compliance to the international guidelines and to assess our neonatal performances in delivery room, we used a Mobotix camera to record all resuscitations of extremely-low-gestational-age neonates during the decisive first minutes of life. Neonatal medical and nursing staff agreed to be recorded. Our local ethics committee approved that videotaping neonatal resuscitation is an audit of clinical practice and thus does not require informed consent. During debriefing sessions, we reviewed the videotaped recordings, which allowed us to identify frequent deviations from the international guidelines and to re-educate and improve performance. The most frequent errors we recognized were errors of hygiene, not re-evaluating oxygen titration and airway obstruction during mask ventilation. We observed team behaviour and coordination during resuscitation and focused on quality of care. We believe that this method may be very effective as a teaching tool.
Dealing with aggressive behavior within the health care team: a leadership challenge
2006, Journal of Critical CareDuring an interdisciplinary Canadian leadership forum [www.ice-ccm.org (click on the Conferences icon)], participants were challenged to develop an approach to a difficult leadership/management situation. In a scenario involving aggressive behavior among health care providers, participants identified that, before responding, an appropriate leader should collect additional information to identify the core problem(s) causing such behavior. Possibilities include stress; lack of clear roles, responsibilities, and standard operating procedures; and, finally, lack of training on important leadership/management skills. As a result of these core problems, several potential solutions are possible, all with potential obstacles to implementation. Additional education around communication and team interaction was felt to be a priority. In summary, clinical leaders probably have a great deal to gain from augmenting their leadership/management skills.
Trials of teaching methods in basic life support (4): Comparison of simulated CPR performance at unannounced home testing after conventional or staged training
2004, ResuscitationThis study compares the retention of basic life support (BLS) skills after 6 and 12 months by lay persons trained either in a conventional manner, or using a staged approach. Three classes, each of 2 h, were offered to volunteers over a period of 4 months. For the conventional group, the second and third classes consisted of review of skills. Those in the staged group were first taught chest compression alone; chest compression with ventilation in a ratio of 50:5 was introduced at the second class; full standard CPR was taught at the third class. A total of 495 volunteers entered the study, 262 being randomly allocated to conventional training, and 233 to staged training. More of those who received staged training attended a second (78 volunteers) and third class (41 volunteers), compared with those who received conventional training (36 and 17, respectively). The objective of this study, however, was to compare the strategies of the different training methods. A total of 291 volunteers (167 conventional and 124 staged training) were available for unannounced home testing of full conventional CPR 6 months after initial training, and 260 volunteers (135 conventional and 125 staged training) were tested at 12 months. At 6 months, those taught by the staged method were significantly better at time to first compression (P<0.0001), compression rate (P=0.024), and hand position (P=0.0001). At 12 months, those taught by the staged method were significantly better at shouting for help (P=0.005), time to first compression (P<0.0001), and compression depth (P=0.003). Those taught conventionally were significantly better at checking for a carotid pulse at both 6 and 12 months (P<0.0001). These results suggest that training lay persons in basic life support skills using a staged approach leads to overall better skill retention at 6 and 12 months, and has other advantages including a greater willingness to re-attend follow-up classes.
Este estudo compara a capacidade de retenção de competência em Suporte Básico de Vida (SBV) após 6 e 12 meses por leigos treinados de forma convencional ou utilizando um treino faseado. Foram realizadas três sessões para voluntários, cada uma de 2 horas, durante um perı́odo de 4 meses. Para o grupo convencional, a segunda e terceiras lições consistem em revisão das competências. Ao grupo de treino faseado primeiro foi ensinado apenas compressão torácica; na segunda lição foi ensinada compressão com ventilação numa taxa de 50:2. A reanimação Cardio-pulmonar completa standard só foi ensinada na terceira lição. Entraram no estudo um total de 495 voluntários, destes 262 foram aleatorizados para treino convencional, e 233 para um treino faseado. A adesão dos voluntários à segunda (78 voluntários) e terceira lição (41 voluntários) foi maior nos que receberam treino faseado do que nos que receberam treino convencional (36 e 17, respectivamente). Contudo, o objectivo deste estudo foi comparar as estratégias de diferentes métodos de treino. Um total de 291 voluntários (167 do treino convencional e 124 do treino faseado) estavam disponı́veis para teste de CPR completa convencional no domicı́lio, sem aviso prévio, 6 meses após o treino inicial; e 260 voluntários (135 do treino convencional e 125 faseado) foram testados aos 12 meses. Aos 6 meses, aqueles que foram ensinados pelo método faseado, foram significativamente melhores no tempo para a primeira compressão (P < 0.0001), na taxa de compressão (P = 0.024) e na posição das mãos (P = 0.0001). Aos 12 meses, aqueles ensinados pelo método faseado foram significativamente melhores no pedido de ajuda (P = 0.005), tempo para a primeira compressão (P < 0.0001), e profundidade da compressão (P = 0.003). Aqueles ensinados pelo método convencional foram significativamente melhores na pesquisa do pulso carotı́deo, quer aos 6 quer aos 12 meses (P < 0.0001). Estes resultados sugerem que o treino dos leigos em suporte básico de vida utilizando um método de ensino faseado leva a melhor retenção das competências, tanto aos 6 como aos 12 meses, e tem outras vantagens incluindo a vontade de voltar a frequentar lições de seguimento.
Este estudio compara la retención de destrezas de soporte vital básico (BLS) después de 6 y 12 meses por parte de personas legas, entrenadas en forma convencional o usando una aproximación por etapas. Se ofrecieron aun grupo de voluntarios tres clases, de 2 hrs cada una, en un lapso de 4 meses. Para el grupo con entrenamiento convencional, la segunda y tercera clase consistieron en revisión de las destrezas. Aquellos en el grupo por etapas, primero se les enseñó solo compresión torácica; en la segunda etapa se les enseñó compresión con ventilación en una frecuencia de 50:2 ; y en la tercera se enseñó reanimación estándar completa. En este estudio participaron 495 voluntarios, siendo colocados aleatoriamente 262 a entrenamiento convencional, y 233 designados a entrenamiento en etapas. De aquellos que recibieron entrenamiento en etapas hubo mas que asistieron a la segunda (78 voluntarios) y tercera clase (41 voluntarios), comparados con aquellos que recibieron entrenamiento convencional (36 y 17 respectivamente). El objetivo de este estudio, sin embargo, fue comparar las estrategias de los diferentes métodos de entrenamiento. Hubo un total de 291 voluntarios (167 convencional, 124 por etapas) disponibles para evaluación en domicilio sin previo aviso, en CPR convencional completo seis meses después de el entrenamiento inicial, y 260 voluntarios (135 convencionales y 125 por etapas) fueron evaluados a los 12 meses. A los 6 meses, aquellos entrenados con método por etapas fueron significativamente mejores en el tiempo a la primera compresión (P < 0.0001), frecuencia de compresiones (P = 0.024), y en posición de manos (P = 0.0001). A los 12 meses, aquellos entrenados por etapas fueron significativamente mejores en gritar por ayuda (P = 0.005), tiempo a la primera compresión (P < 0.0001), y profundidad de las compresiones (P = 0.003). Aquellos entrenados en forma convencional fueron significativamente mejor en buscar pulso carotı́deo tanto a los 6 como a los 12 meses (P < 0.0001). Estos resultados sugieren que el entrenamiento de personas legas en destrezas de soporte vital básico usando una aproximación por etapas lleva a una mejor retención global de las destrezas a los 6 y 12 meses, y tiene otras ventajas que incluyen mayor disposición para asistir nuevamente a las clases de refuerzo y seguimiento.
Videotape review leads to rapid and sustained learning
2003, American Journal of SurgeryPerformance review using videotapes is a strategy employed to improve future performance. We postulated that videotape review of trauma resuscitations would improve compliance with a treatment algorithm.
Trauma resuscitations were taped and reviewed during a 6-month period. For 3 months, team members were given verbal feedback regarding performance. During the next 3 months, new teams attended videotape reviews of their performance. Data on targeted behaviors were compared between the two groups.
Behavior did not change after 3 months of verbal feedback; however, behavior improved after 1 month of videotape feedback (P <0.05) and total time to disposition was reduced by 50% (P <0.01). This response was sustained for the remainder of the study.
Videotape review can be an important learning tool as it was more effective than verbal feedback in achieving behavioral changes and algorithm compliance. Videotape review can be an important quality assurance adjunct, as improved algorithm compliance should be associated with improved patient care.
Randomised controlled trials of staged teaching for basic life support: 1. Skill acquisition at bronze stage
2000, ResuscitationWe have investigated a method of teaching community CPR in three stages instead of in a single session. These have been designated bronze, silver, and gold stages. The first involves only opening of the airway and chest compression with back blows for choking, the second adds ventilation in a ratio of compressions to breaths of 50:5, and the third is a conversion to conventional CPR. In a controlled randomised trial of 495 trainees we compared the performance in tests immediately after instruction of those who had received a conventional course and those who had had the simpler bronze level tuition. The tests were based on video recordings of simulated resuscitation scenarios and the readouts from recording manikins. Differences occurred as a direct consequence of ventilation being required in one group and not the other, some variation probably followed from unforeseen minor changes in the way that instruction was given, whilst others may have followed from the greater simplicity in the new method of training. A careful approach was followed by slightly more trainees in the conventional group whilst appreciably more in the bronze group remembered to shout for help (44% vs. 71%). A clear advantage was also seen for bronze level training in terms of those who opened the airway as taught (35% vs. 56%), for checking breathing (66% vs. 88%), and for mentioning the need to phone for an ambulance (21% vs. 32%). Little difference was observed in correct or acceptable hand position between the conventional group who were given detailed guidance and the bronze group who were instructed only to push on the centre of the chest. The biggest differences related to the number of compressions given. The mean delay to first compression was 63 s and 34 s, and the mean duration of pauses between compressions was 16 s and 9 s, respectively. Average performed rates were similar in the two groups, but more in the conventional group compressed too slowly whereas more in the bronze group compressed too rapidly. Observations were made for only three cycles of compression, but extrapolating these to the 8 min often considered a watershed for chances of survival for victims of cardiac arrest, an average of 308 compressions would be expected from those using conventional CPR compared with 675 for those using bronze level CPR. The implications of this difference are discussed.