# 4. Learning from success stories

Hospitals implementing video review often develop successful approaches to obtaining consent. These approaches include:

* **Clear Communication:** Providing patients and staff with detailed information about video recording, how it will be used, and their rights regarding consent.
* **Triple Provider Consent:** Obtaining consent from all team members involved in the procedure before recording, after recording, and before using the video for review.
* **Opt-in Systems:** Allowing staff to choose whether to participate in recording sessions based on their comfort level.
* **Respectful Dialogue:** Creating an environment where patients and staff feel comfortable asking questions and raising concerns about consent.

By prioritizing informed consent and learning from established practices, you can help ensure your video review program fosters trust, transparency, and continuous improvement in patient care. Below we highlight the set-up of four different centers who have successfully implemented video recording and reviewing in their unit.&#x20;

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{% tab title="NICU LUMC" %}
**Recordings include:**

## Two fixed cameras recording neonatal stabilization

* Type of recording:
  * Identifiable recordings; providers are audio-visually identifiable in the video. Family can be visible if they enter the room. Infant is visible.&#x20;
    * Equipment: GoPro camera (full room-view of delivery room) & Rhode microphone.&#x20;
  * Unidentifiable recordings; only the hands of the providers and the infant are shown, no audio.
    * Equipment: Microsoft Lifecam camera. Including Respiratory Function Monitoring (Polybench).

## **Wearable camera recording procedures in the NICU environment (endotracheal intubation, surfactant administration, sterile procedures, etc.)**

* Type of recording:
  * Identifiable recordings; providers are audio-visually identifiable in the video. Infant is visible. Family can be visible if they are in the room.
    * Equipment: eye-tracking glasses (Tobii pro)

**Patient Consent:**&#x20;

* **Unidentifiable recordings of neonatal stabilization:** Videos without faces or identifying features or medical providers are considered part of the medical record. Parents can view and request copies of these recordings. No patient consent is asked.
* **Identifiable recordings of neonatal stabilization and procedures in the NICU environment:** Recordings are made for solely quality assurance purposes, so no patient consent is asked. However, if family is visible, consent is required before using the video for video review, aimed at quality improvement. The recordings of neonatal stabilization are reviewed with parents to obtain their perspective on this critical period so they can provide input for our review session regarding their feelings and needs during the stabilization period.

**Provider Consent:**

* **Unidentifiable recordings of neonatal stabilization:** Team members were informed about these recordings and have the option not to have the unidentifiable recording made or used. However, this has become part of standard care and now almost every stabilization is recorded standardly.
* **Identifiable Recordings:** Providers maintain control over whether their procedures are identifiable recorded and reviewed, using a [triple consent](https://lennartvandermolens-organization.gitbook.io/neoflix/level-2-in-action/5.-preparation-and-consent/5.1-obtain-consent) procedure (before recording, after a recording and before use of a video for a review session)

**Review use:**

* Videos are discussed in video review sessions with medical and nursing staff (on average 17 providers per session in total)
* Sessions are focused on ensuring a safe learning environment
* Sessions take 30 minutes, and are organized biweekly
* Video review is used to drive change, by translating the discussion points into actionable items.&#x20;
* Parents have the possibility to review the recordings and can request a copy or screenshot.&#x20;

**Storage**

* All recordings are stored an a protected local server, only designated team-members can access this server.&#x20;
* Identifiable recordings are removed after use, unidentifiable recordings are stored as part of the medical record of the patient and can be used for research purposes.

<mark style="color:green;">**Pros**</mark>

* **Critical Event Capture:** Enables recording of urgent procedures where obtaining immediate consent from patients is impractical.
* **Provider Autonomy:** Respects providers' choice to participate or not.
* **Parent Engagement:** the unidentifiable recordings that are shared with parents enhance transparency and family-centered care.

<mark style="color:red;">**Cons**</mark>

* **Patient Privacy Concerns:** The infant is visible in recordings, family can be visible.&#x20;
* **Limited Long-Term Research:** Deleting identifiable recordings restricts their use for future research.
* **Incomplete Data Set:** Voluntary participation means not every procedure will be recorded as standard.

**If you have any questions, regarding this approach, feel free to contact this center at <neoflix@lumc.nl> or <r.witlox@lumc.nl>**

<figure><img src="https://content.gitbook.com/content/dxZ2ighBkUj6xAygqIgF/blobs/S7aienYYvbHbGemyZKDy/Visualizatie%20sfeer%20neoflix.png" alt=""><figcaption></figcaption></figure>
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{% tab title="NICU Australia" %}

### Fixed cameras recording neonatal stabilization

**Type of recording:**

* Infant is visible, hands and arms of providers, voice clearly audible.
* Equipment: GoPro camera (full room-view of delivery room), including view of respiratory parameters through a wide-angle lens (removable attachment), fixed to resuscitator using magnets.
* Challenge: overheating of camera

**Patient Consent:**

* Waiver of parental consent to use for educational and quality assurance activities at Monash Health since 2019. Researchers are obligated to keep the videos in a password-protected secure location for 7 years in accordance with Victoria, Australia standards.
* If researchers want to use the data for research, they have submitted additional ethics applications.
* If researchers want to use individual videos for conferences, cases, or publications, they have used their hospital's standardized case report form to discuss with parents for consent.

**Provider Consent:**

* Verbal acknowledgement prior to videoing and a more formal verbal (or email/text) consent prior to using for reviewing is obtained.
* Review sessions tend to be at junior doctor learning sessions or nursing in-services, which are separate. Typically, they will seek the permission of the fellow managing the airway and the nurse in charge of the monitoring.
* They have standing consent from all consultants and get permission from other providers who may have made contact with the baby as needed, depending on their level of involvement.

**Review use:**

* This center has had 64 formal learning sessions on record with a sign-in sheet that also doubles as consent for the rules of participation in a video review session: Everyone in the room and on the video is smart, well-trained, trying their best, wants to improve, and everything in the session is confidential.
* In the last 4.5 years (since starting in Sept 2019 through Jan 2024), they have recorded 108 resuscitations. 37 videos have been formally reviewed. This center has run 64 total formal sessions, 37 for junior doctors, 9 for RNs, 8 for mixed groups (junior doctors and consultants, multiple disciplinary QI groups), and 10 private 1:1 coaching sessions, totaling 408 participants.
* In August 2020, they added NRVR to the Monash Health Advanced NeoResus training as a 45-minute video featuring highlights from their video review program. NeoResus is a national Neonatal Resuscitation training program in Australia, similar to NRP. This 45-minute review has been seen in the 16 subsequent advanced NeoResus training days, with an estimated 380 students.

**Usage**

* Staff education and as an adaptation to a nationally recognized Neonatal Resuscitation training project for Monash Health staff.
* Occasional review by relevant working groups.
* Researchers are running a project in 2024 to study the benefits of 1:1 junior doctor coaching and 1:1 RN coaching.
* NRVR can also be used as standard data available for neonatal resuscitation research projects, as available.

**Storage**

* Recordings are managed as an ethics-approved QA project, with an obligation to maintain records and videos for 7 years per state standards.
* Recordings are not part of the medical record of the patient.
* Stored digitally in a password-protected, secure location. Researchers attempt to de-identify files by using a QA project number.

**Pros**

* Critical Event Capture: Enables recording of urgent procedures where obtaining immediate consent from patients is impractical.
* Provider Autonomy: Respects providers' choice to participate or not.
* One camera: Through the wide-angle lens, researchers only require one camera to obtain a view of the procedure and the respiratory parameters.

**Cons**

* Patient Privacy Concerns: The infant is visible in recordings, and family can be visible.
* Recordings are not part of the medical record of the patient and/or shared with parents.

**If you have any questions, regarding this approach, feel free to contact this experienced center at** <doug.blank@monash.edu>

<div><figure><img src="https://3840869088-files.gitbook.io/~/files/v0/b/gitbook-x-prod.appspot.com/o/spaces%2FdxZ2ighBkUj6xAygqIgF%2Fuploads%2FiI5QyUflkcfOK3uXwzjP%2FAustralia%201.png?alt=media&#x26;token=3478256e-1bab-475a-890a-bb4126fde6dd" alt=""><figcaption></figcaption></figure> <figure><img src="https://3840869088-files.gitbook.io/~/files/v0/b/gitbook-x-prod.appspot.com/o/spaces%2FdxZ2ighBkUj6xAygqIgF%2Fuploads%2Fp2fabXxSrWzrcqN2G33A%2FAustralia%202.png?alt=media&#x26;token=fb3c6f35-acb6-407a-b875-99b8ee3c158d" alt=""><figcaption></figcaption></figure> <figure><img src="https://3840869088-files.gitbook.io/~/files/v0/b/gitbook-x-prod.appspot.com/o/spaces%2FdxZ2ighBkUj6xAygqIgF%2Fuploads%2FrgvqEvPMcwl5cNva6OqV%2FAustralia%203.png?alt=media&#x26;token=1051d5f4-baa6-4443-b16b-5da74e796133" alt=""><figcaption></figcaption></figure></div>
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{% tab title="NICU Vienna" %}

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{% tab title="NICU Philadelphia" %}

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