Using educational video to enhance protocol adherence for medical procedures.

BACKGROUND Better education of clinicians is expected to enhance patient safety. An important component of education is adherence to standard protocols, which are mainly available in written form. Believing in the potential power of videos, we hypothesized that the introduction of an educational video, based on an institutional standard protocol, would foster adherence to the protocol. METHODS We conducted a prospective intervention study of 425 anaesthesia procedures and teams (202 pre-video and 223 post-video) involving 1091 team members (516 pre-video and 575 post-video) in seven individual operating areas (with a total of 30 operating rooms) in a university hospital. Failure of adherence to safety-critical tasks during rapid sequence anaesthesia inductions was assessed during systematic on-site observations pre- and post-introduction of an educational video demonstrating evidence-based and best practice guidelines. RESULTS The odds for failure of adherence to safety-critical tasks between the pre- and post-intervention period were reduced, odds ratio 0.34 (95% confidence interval 0.27-0.42, P<0.001). The risk for failure of adherence was reduced significantly for eight of the 14 safety-critical tasks (all P<0.001). CONCLUSIONS This study provides empirical evidence for the effectiveness of an educational video to enhance adherence to a standard protocol during complex medical procedures. The introduction of a video can reduce failure of adherence to safety-critical tasks and contribute to patient safety. We recommend the introduction of videos to improve protocol adherence.

[1]  J. Nordmark,et al.  Scandinavian clinical practice guidelines on general anaesthesia for emergency situations , 2010, Acta anaesthesiologica Scandinavica.

[2]  B. Seifert,et al.  An Anesthesia Preinduction Checklist to Improve Information Exchange, Knowledge of Critical Information, Perception of Safety, and Possibly Perception of Teamwork in Anesthesia Teams , 2015, Anesthesia and analgesia.

[3]  W. Berry,et al.  Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention , 2011, Quality and Safety in Health Care.

[4]  Elizabeth R DeLong,et al.  Association between hospital process performance and outcomes among patients with acute coronary syndromes. , 2006, JAMA.

[5]  R. Galgon,et al.  Teaching sonoanatomy to anesthesia faculty and residents: utility of hands-on gel phantom and instructional video training models. , 2015, Journal of clinical anesthesia.

[6]  J. Holcomb,et al.  Compliance with recommended care at trauma centers: association with patient outcomes. , 2014, Journal of the American College of Surgeons.

[7]  Anuj K. Dalal,et al.  Changes in medical errors after implementation of a handoff program. , 2014, The New England journal of medicine.

[8]  S. Mohammed,et al.  Metaphor No More: A 15-Year Review of the Team Mental Model Construct , 2010 .

[9]  Eduardo Salas,et al.  Planning, Shared Mental Models, and Coordinated Performance: An Empirical Link Is Established , 1999, Hum. Factors.

[10]  Johannes Wacker,et al.  Speaking Up Is Related to Better Team Performance in Simulated Anesthesia Inductions: An Observational Study , 2012, Anesthesia and analgesia.

[11]  Jane Garbutt,et al.  The emotional impact of medical errors on practicing physicians in the United States and Canada. , 2007, Joint Commission journal on quality and patient safety.

[12]  W. Berry,et al.  A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population , 2009, The New England journal of medicine.

[13]  R J Lilford,et al.  An epistemology of patient safety research: a framework for study design and interpretation. Part 2. Study design , 2008, Quality & Safety in Health Care.

[14]  M. Durieux,et al.  The Impact of Perioperative Catastrophes on Anesthesiologists: Results of a National Survey , 2012, Anesthesia and analgesia.

[15]  Mark Clayton Delphi: a technique to harness expert opinion for critical decision‐making tasks in education , 1997 .

[16]  D. Torgerson,et al.  The Design and Conduct of Randomised Controlled Trials in Education: Lessons from health care , 2003 .

[18]  R. Thomson,et al.  An epistemology of patient safety research: a framework for study design and interpretation. Part 3. End points and measurement , 2008, Quality & Safety in Health Care.

[19]  Gudela Grote,et al.  Silence that may kill: When aircrew members don’t speak up and why. , 2012 .

[20]  C. Gersick,et al.  Habitual routines in task-performing groups. , 1990, Organizational behavior and human decision processes.

[21]  A. Bader,et al.  Adopting a surgical safety checklist could save money and improve the quality of care in U.S. hospitals. , 2010, Health affairs.

[22]  M. Cabana,et al.  Why don't physicians follow clinical practice guidelines? A framework for improvement. , 1999, JAMA.

[23]  C. Gibson,et al.  Team Implicit Coordination Processes: A Team Knowledge–Based Approach , 2008 .

[24]  J. Reason Human error: models and management , 2000, BMJ : British Medical Journal.

[25]  D. Spahn,et al.  How to Conduct Multimethod Field Studies in the Operating Room: The iPad Combined With a Survey App as a Valid and Reliable Data Collection Tool , 2016, JMIR research protocols.

[26]  Jordi Rello,et al.  Why do physicians not follow evidence-based guidelines for preventing ventilator-associated pneumonia?: a survey based on the opinions of an international panel of intensivists. , 2002, Chest.

[27]  Stuart R. Lipsitz,et al.  Effect of A 19-Item Surgical Safety Checklist During Urgent Operations in A Global Patient Population , 2010, Annals of surgery.

[28]  David A Cook,et al.  Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. , 2011, JAMA.

[29]  A. Donihi,et al.  Use of an iPad to Provide Warfarin Video Education to Hospitalized Patients , 2015, Journal of patient safety.

[30]  J. Henderson,et al.  Difficult Airway Society guidelines for management of the unanticipated difficult intubation , 2004, Anaesthesia.

[31]  C. Pfeiffer,et al.  Using web-based video to enhance physical examination skills in medical students. , 2008, Family medicine.

[32]  E. D. de Vries,et al.  Effect of a comprehensive surgical safety system on patient outcomes. , 2010, The New England journal of medicine.

[33]  Emilie M. Roth,et al.  Can We Ever Escape from Data Overload? A Cognitive Systems Diagnosis , 1999, Cognition, Technology & Work.

[34]  E. D. de Vries,et al.  Prevention of Surgical Malpractice Claims by Use of a Surgical Safety Checklist , 2011, Annals of surgery.

[35]  K. Alexander,et al.  Doing the Right Things and Doing Them the Right Way: Association Between Hospital Guideline Adherence, Dosing Safety, and Outcomes Among Patients With Acute Coronary Syndrome , 2015, Circulation.

[36]  Christine W Hartmann,et al.  Identifying organizational cultures that promote patient safety , 2009, Health care management review.

[37]  J. Mcgowan,et al.  Improving the quality of colonoscopy bowel preparation using an educational video. , 2013, Canadian journal of gastroenterology = Journal canadien de gastroenterologie.

[38]  R Flin,et al.  Beyond monitoring: distributed situation awareness in anaesthesia. , 2010, British journal of anaesthesia.