Video surveillance has become increasingly pervasive. It is being used to prevent shoplifting, for homeland security at public events, police officers wearing cameras, in airplane cockpits and train locomotives, and for “instant replay” in college and professional sports.
Which led to me research a bit about the use of video surveillance cameras in hospitals.
There was an article this year about “Operating room staff are heard on the recording making rude comments about Ms. Easter while she is sedated. A surgeon calls Ms. Easter “a handful” and is heard laughing about how upset Ms. Easter was when she was told how long she would have to wait to schedule her surgery. The surgeon also comments that he feels sorry for Ms. Easter’s husband. OR staff also made derogatory comments about Ms. Easter’s body. Laughter is recorded in the OR after a female voice, which Ms. Easter claims is that of an OR nurse, is heard saying, “Did you see her belly button?” (A)
And I remember the 2002 episode where” “Massachusetts… indefinitely suspended a surgeon’s medical license because he left a patient anesthetized on an operating table with an open incision in his back while he went to a bank several blocks away.” (B)
A classic situation is Munchausen syndrome by proxy. “…a mental illness and a form of child abuse. The caretaker of a child, most often a mother, either makes up fake symptoms or causes real symptoms to make it look like the child is sick.” (C) “Beatrice Crofts Yorker, RN, JD,… writes that she has personally observed a videotape (of a hospitalized child) that showed a mother rinsing a thermometer under running water and then calling in the nurse to read an elevated temperature (covert video surveillance). Indeed, some hospitals have employed covert videotaping to observe the alleged perpetrator’s (mother’s) behavior with the child.” (D)
Some of the articulated benefits that video surveillance provides include: “Keeps patients’ records and identities safe; Ensures staff are meeting health and safety standards; Allows for remote monitoring from a smartphone or tablet; Prevents intruders from gaining access to restricted areas; Deters vandalism and other criminal acts; Increases safety for patients and staff.” (E)
And much has been written about using video surveillance to monitor hand washing and improve compliance. “For example, Summerville Medical Center, a 94-bed acute-care hospital in South Carolina, is having employees wear sensor tags to determine who is washing their hands before and after coming into contact with patients. The technology was first rolled out in the medical center’s intensive care unit in the spring of 2012 and then expanded to its surgery units and the emergency room. Each hospital caregiver wears a badge-like sensor tag that counts room entries and exits as well as the use of soap or sanitizer dispensers. The data collected from the system is used to model and characterize clinician-patient interactions, providing detailed data to help monitor and modify behavior. (F)
“At North Shore University Hospital on Long Island, motion sensors, like those used for burglar alarms, go off every time someone enters an intensive care room. The sensor triggers a video camera, which transmits its images halfway around the world to India, where workers are checking to see if doctors and nurses are performing a critical procedure: washing their hands.” (G)
But there are skeptics. “Another potential issue with the video observation is a false accusation of failure to wash. Patient rooms and patients themselves are not being watched. Let’s say a nurse went into a patient’s room to tell him something and didn’t touch anything. A person in India watching a video from a camera focused on a door or sink would not be able to tell that. If the nurse doesn’t wash her hands when she leaves the room, is she going to be cross-examined? (H)
“Operating rooms have long been equipped with cameras for security and training purposes. But video technology has rarely been used to improve patient care. ……… staff check in with the videos once every two minutes, and follow a checklist to look out for errors that could creep into surgery when staff skip steps in safety protocols. The data they collect on the performance of each team is then streamed real-time to the frontlines of the operating room; the medical teams and staff in charge can view the information on their smartphones.” (I)
“An eICU support center can provide care to patients in multiple hospitals. The goal of an eICU initiative is to optimize clinical expertise and facilitate 24-hour-a-day care by ICU caregivers, whether the caregivers are down the hall from the patient that’s being monitored or in another city. Two-way cameras, video monitors, microphones and smart alarms connected by high speed data lines provide eICU caregivers, who are called intensivists, with real-time patient data around the clock. Intensivists can also communicate with on-site caregivers through dedicated telephone lines. “ (J)
Some examples are useful “Chris Nowakowski’s wife died in Wisconsin during what should have been a routine procedure on her pacemaker. Danny Long’s wife in North Carolina suffered catastrophic neurological injury during a surgery to relieve numbness in her extremities. A doctor perforated the colon and esophagus of Deirdre Gilbert’s daughter in Texas, then operated on her after she was dead. In each case, the families still don’t know the full story of what happened to their loved ones because of a lack of documentation and an inability to pursue a costly lawsuit. They are relatives of an estimated 400,000 a year people who die in the United States of preventable medical errors, the third-leading cause of death after heart disease and cancer. But the families say they could have known much more if cameras had been installed in the operating rooms, recording the actions and movements of the doctors and staffers involved.” (K)
“There’s a growing movement in the United States to install video cameras in operating rooms (ORs)….. The idea is to document possible adverse events and thereby prevent similar ones from occurring in the future, but critics worry that recording devices in the OR would not only compromise patient and doctor privacy but lead to a wave of new malpractice lawsuits.
The camera-in-the-OR movement has taken off because of a number of high-profile medical mistakes. A woman named Julie Ayer Rubenzer died after breast-enhancement surgery done in Florida, after she was given excessive amounts of propofol, the same anesthetic that led to the 2009 death of pop star Michael Jackson.” (L)
“However the benefits of having video evidence in the operating rooms could be enormous. Think of the abusive surgeon who terrorizes the entire OR staff. Finally there will be evidence for disciplinary action, instead of just another he said/she said in front of some hospital committee. Wrong site surgery can be analyzed so that others can see what went wrong instead of reading through vague medical records which pretty much parrot the hospital’s time out protocol and doesn’t give any insight into how the mistake was made. Lap sponges left in the patient? The unblinking eye of the camera can show why the sponge was not counted properly at the end of the case. Were the nurses distracted by a shift change? Was the music too loud causing people not to be able to hear each other clearly? Was the count wrong at the beginning of the case and nobody noticed? All these could be answered by a simple video.” (M)
But not everyone agrees. “What scares me is the intent of such a policy. What exactly would a videotaped be used for? So the patient can watch it? Surely the patient will have no clue what he or she is watching. If the videotape is going to be used for malpractice, then I think patients will be the ones who suffer. Everybody in medicine knows that although surgical technique is standard, it varies widely. You will always find someone who is willing to say that your technique is not the standard of care. How they operate in Boston is not necessarily how they operate in San Francisco. Thus I don’t really think their (sic) is much utility because the nature of medicine and surgery is constant criticism to improve practice. This however is different from critique in the form of malpractice.” (N)
Which raises a number of medical ethics challenges, e.g. “Should a patient be able to refuse video surveillance? If so, shouldn’t the hospital be allowed to refuse medical care to patients that do not consent? Kind of like walking into an airport and refusing to be video recorded. If you don’t want to be videotaped, find another means of travel. For now, smile … if you enter a hospital, you’re going to be on camera. Ethics committee approval notwithstanding.” (O)
“Healthcare can benefit from the power of cameras to improve accountability,” Makary, Pawlik and Xu conclude. “In an era where 86% of nurses report having recently witnessed disruptive behavior 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. 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.” (P))
The use of technology in medical care is a reality “to improve clinical care and slash error rates, and to reduce patient stress, encouraging healing.” (Q)
Advanced patient safety technology should be embraced!