1.4.1 Safe: Obtaining consent

Keep it safe

Navigating the Complexities of Video Review

While video review offers tremendous benefits for patient care, quality improvement, research, and education, its implementation requires careful consideration:

• Balancing Interests: Different stakeholders (patients, providers, researchers) may have varying needs and priorities regarding video usage. Finding the right balance is crucial.

• Ethical Considerations: Protecting patient privacy and provider autonomy is essential. Open dialogue with all involved parties will help address potential concerns.

• Legal Uncertainties: While quality improvement recordings often receive legal protection, their use in potential court proceedings remains a gray area. Seek guidance from your legal team.

Important Reminders:

• Adverse Event Reporting: This remains a mandatory obligation, regardless of video recordings.

• Informed Consent: Choose a consent model suitable for your setting, addressing both patient and provider rights.

Addressing these complexities proactively will ensure a smooth and ethically responsible implementation of video review in your practice.

Consider the following questions:

Patient consent

-> When and how are patients informed?

-> Should patients explicitly consent?

-> Can patients request to delete recordings?

-> Who can be contacted in case of questions?

-> Will recordings be shared with patients?

Research on the neonatal intensive care unit (NICU), showed that sharing recordings of neonatal stabilization with parents, can be beneficial for parents and their coping. Parents of infants admitted to the NICU of the Leiden University Medical Center (LUMC), reviewed recordings and reported that they appreciated it and doing so, made them less likely to hold providers responsible for medical malpractice (den Boer et al. 2021).

Provider consent

-> When and how are providers informed?

-> Should providers explicitly consent?

-> Can individual providers refuse recording or reviewing?

Different consent approaches from centers who have implemented video review:

NICU LUMC

Recordings:

• Videos of neonatal stabilization

  • Identifiable recordings

  • Unidentifiable recordings

• Videos of procedures on the NICU, such as endotracheal intubation, surfactant administration, sterile procedures etc.

  • Identifiable recordings

Patient Consent:

• Unidentifiable Recordings: Videos without faces or identifying features or medical providers are considered part of the medical record. Parents can view and request copies.

• Identifiable Recordings: recordings are made for solely quality assurance purposes, so no patient consent is asked. However, if parents are visible, consent is required before using the video for quality improvement.

Provider Consent:

• Opt-Out Approach: Team members are informed about video review and can choose not to have identifiable recordings made or used.

• Voluntary Participation: Providers maintain control over whether their procedures are recorded and reviewed.

• Deletion After Study: Identifiable recordings are deleted after the project period.

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.

• Parent Engagement: the unidentifiable recordings that are shared with parents enhance transparency and family-centered care.

Cons

• Patient Privacy Concerns: Careful procedures are vital for protecting patient privacy, especially with identifiable recordings.

• Limited Long-Term Research: Deleting identifiable recordings restricts their use for future studies.

• Incomplete Data Set: Voluntary participation means not every procedure will be recorded as standard.

Key Takeaway: Your approach strikes a balance between respecting patient and provider rights and enabling valuable video review. Openly addressing the pros and cons will help build team-wide understanding and acceptance.

NICU AMC

NOG CHECKEN MET RUUD!!!

Type of videos

• Videos of neonatal stabilization

  • Unidentifiable recordings

Patient consent

Unidentifiable videos of neonatal resuscitation in the delivery room (in which the neonate and hands of the providers were visible) were part of the medical record of the patient and were stored on protected servers. All neonatal resuscitations are recorded as part of standard care on our NICU. The non-anonymous audio-visual videos of neonatal resuscitations and interventions on the NICU are used for quality improvement only. No patient consent is asked before recording.

Provider consent

Consent from providers was obtained before any identifiable recording. When someone was accidentally captured on film without permission, their permission was sought afterwards. The recordings were stored on protected servers and only designated team members of the study group had access to the recordings. All providers of the NICU-team were informed about implementation of video review beforehand and were given the opportunity to opt out of (identifiable) recordings of interventions. It was emphasized that recording an intervention should remain voluntary. If team members wanted to opt-out, before or after a recording had been made, a dedicated member of the study group could always be approached. Identifiable recordings were deleted after the study period.

Pro's

Con's

NICU Vienna

CHECKEN MET MICHAEL / HANNAH

Philadelphia

CHECK MET HEIDI HERRICK

NICU Dresden

CHECK MARIO