Patient Perceptions of Audio and Video Recording in the Operating Room

Abstract

The goal of this study was to determine surgical patients' perceptions of hypothetical continuous audio-video OR recording (ORR). Summary of Background Data: Continuous audio-video recording of the operating room (OR), akin to the aviation industry's black box, has been proposed as a means to enhance training, supplement the medical record, and allow large-scale analysis of surgical performance and safety. These recordings would include patients' bodies; yet, understanding of patient perceptions regarding such technology is limited. Methods: Semi-structured interviews were conducted during elective surgery preoperative appointments during a 2-week period in August 2018 at a quaternary care center. Deidentified transcripts were analyzed using thematic analysis. Results: Forty-nine subjects were interviewed. Subjects recognized the potential for recording to improve surgical quality, safety and training. Subjects also desired access to an objective record of their own surgery, for the purposes of future care, medical-legal evidence, and to satisfy their own curiosity and understanding. Subjects had mixed perceptions regarding OR decorum and thus, differing views on the potential effect of ORR on OR behavior; some imagined that ORR would discourage bad behavior and others worried that it would cause unnecessary anxiety to the surgical team. Conclusions: Patients have a diverse set of views about the potential benefits, risks, and uses for OR data and consider themselves to be important stakeholders. Our study identifies pathways and potential challenges to implementation of continuous audio/video recording in ORs.

Implementation of an Innovative Technology Called the OR Black Box: A Feasibility Study

“…Some of the primary concerns that participating staff had, especially among those who declined to provide consent, were data security, deidentification, and legal issues. These concerns, mainly verbally expressed during formal information meetings held by the research group but also informal encounters with staff and management, are in line with findings at other OR Black Box sites in North America and Europe, 24 – 26 as well as from other initiatives with audio- and video recordings. 27 , 28 To expand knowledge on these perceptions, qualitative studies should be designed and carried out.…”

Navigating a Path Towards Routine Recording in the Operating Room

“…Yet, these recordings might also enable better individual care (eg, helping the care team investigate causes of post-operative complications or plan a reoperation), raising clinical arguments for systematically including procedural video in the medical record so they are available for future care. Some patients are also interested in recordings of their procedures for curiosity and understanding 3 …”

Could, Should Families Watch Their Loved One's Surgeries and, If So, When?

“…However, more frequently, patients raised concerns that recordings could distract the surgical team and saw the primary benefit to be as medicolegal documentation. 1 Clinicians similarly view the benefits of recording as a tool to improve surgical quality, safety, and training, 1 but clinician discussion around implementation of surgical recordings balance the quality and safety improvements from such recordings against the degree to which such recordings will impact litigation. 20 Although not a formal OR recording, a patient recently successfully sued for damages from the distress caused from listening to the OR discussion he inadvertently recorded on his smart phone while sedated undergoing a procedure.…”

“…With growing national dialogue about quality transparency in health care, increasing numbers of families are requesting to observe procedures, and to make what happens in the OR more accessible and transparent to patients and families. 1,2 Care locations are becoming more fluid, with patients often moving between the emergency room (ER), imaging, the OR, and the intensive care unit (ICU) for resuscitations and diagnostic procedures that will inform acute decisions. Locations like the ICU and ER often have spaces that can be rapidly converted from bedspace into ORs.…”

“…With growing national dialogue about quality transparency in health care, increasing numbers of families are requesting to observe procedures, and to make what happens in the OR more accessible and transparent to patients and families. 1,2…”