title: Remote video auditing with real-time feedback in an academic surgical suite improves safety and efficiency metrics: a cluster randomised study.
abstract: 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.
  
  
  
  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.
  
  
  
  Prospective, cluster randomised study in a 23-operating room (OR) suite.
  
  
  
  Surgeons, anaesthesia providers, nurses and support staff.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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%).
  
  
  
  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.
authors.affiliation: Department of Anesthesiology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Overdyk
authors.affiliation: Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA.
authors.forename: Oonagh
authors.initials: O
authors.lastname: Dowling
authors.affiliation: Department of Anesthesiology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Newman
authors.affiliation: Department of Anesthesiology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: David
authors.initials: D
authors.lastname: Glatt
authors.affiliation: Department of Anesthesiology, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Chester
authors.affiliation: Department of Anesthesiology, North Shore-LIJ Health System, Lake Success, New York, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Armellino
authors.affiliation: Department of Anesthesiology, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Cole
authors.affiliation: Department of Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA.
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Landis
authors.affiliation: Department of Biostatistics, Massachusetts General Hospital Biostatistics Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: David
authors.initials: D
authors.lastname: Schoenfeld
authors.affiliation: Department of Anesthesiology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: DiCapua
mesh_terms: D057189:Checklist / Q000592:standards*; D017598:Efficiency, Organizational / Q000592:standards*; D000068156:Formative Feedback; D019983:Guideline Adherence; D006801:Humans; D008485:Medical Audit / Q000379:methods*; D009873:Operating Rooms / Q000592:standards*; D010348:Patient Care Team / Q000592:standards; D061214:Patient Safety / Q000592:standards*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D060145:Text Messaging; D014743:Videotape Recording
keywords: Anaesthesia; Checklists; Crew resource management; Healthcare quality improvement; Surgery