의료의 질 향상 - 비디오 녹화의 힘

(출처 : http://www.golocalise.com/en/studios)

의료분야에 있어서 (기관이나 사람에 따라) 질적 차이가 크다는 것과 

의료진이 근거중심 진료를 잘 따르지 않는 것은 잘 알려진 문제이다. 

더 많은 교육을 하는 것은 이들 문제의 해결책이 되지 못한다. 

지식은 이미 충분하나, 실제로 이행하는 것에서 뒤쳐지기 때문이다. 

여기서는 의료 과정을 비디오 녹화하는 기존의 기술을 이용함으로써 

의료의 질이 향상될 수 있다는 것에 대해 이야기하고자 한다.

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IN MEDICINE, THE PROBLEMS OF WIDE VARIATIONS IN quality and poor compliance with evidence-based care are well known. More education is not the solution for these problems. Knowledge is abundant, but implementation of knowledge often lags. This Viewpoint explores whether use of an existing technology, video recording of medical procedures, can improve quality of care.

Although the World Health Organization’s hand washing declaration and aggressive global awareness campaign has been long established, behavior change among health care workers remains a persistent struggle

The concept of measuring quality for learning is not a proposal to rewire hospitals and install cameras, but rather, a consideration that many applicable activities and procedures are already video based

At Indiana University, Rex et al2 decided to use the recording feature of colonoscopy video equipment to address the long-standing problem of quality variations in colonoscopies

The researchers then informed the gastroenterologists that their procedures were being video recorded and peer reviewed. Following the announcement, mean inspection time during colonoscopy increased by 49% and quality of mucosal inspection improved by 31%,2 suggesting a substantial improvement in quality because of the Hawthorne effect.

Peer review of videos can also enhance existing quality improvement efforts.3

better inform morbidity and mortality conferences

exportability of video files can facilitate external review

In addition to reviews triggered by patient harm, video recording also offers a valuable opportunity for coaching. In the same way that athletes learn from coaches when jointly watching videos of past games, physicians can also learn from their performance by viewing with a coach.

Developing independent coaching networks will require an investment by hospitals, professional physician associations, and a new infrastructure, but the potential reward of improving procedure quality and safety may be substantial.

According to the 2012 Institute of Medicine Best Care at Lower Cost report, unnecessary medical care may account for as much as 30% of US health care expenditures.5

Transparency through video recording in medicine may help to decrease waste in health care through increased accountability.7

Even for appropriate procedures, saving a video of the procedure could be valuable for future physicians when treating a patient

Patients also appear to support the idea of having their procedures recorded. In one study in which 248 patients were asked if they would be interested in receiving a video of their procedure, 81% said yes and 61% were willing to pay for it.8

Video recording of procedures also might help address the chronic problem of disruptive behavior in medicine. In a study of 50 hospitals, 86% of nurses and 47% of physicians reported witnessing disruptive behavior by physicians and nurses.9

There are, of course, some important boundaries to video recording for quality improvement. Patients must be informed that their medical procedure will be recorded and given the option to decline. If they opt to receive a copy of their procedure video, they should be properly informed about what to expect so that the known imprecisions intrinsic to medical procedures that are within the standard of care do not cause false alarm.

In the new era of data storage, the adoption of video recording to improve quality and safety should be more widely implemented. Based on early observations, this approach also could help drive quality improvement to the next level.

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JAMA. 2013 Apr 17;309(15):1591-2. doi: 10.1001/jama.2013.595.

The power of video recording: taking quality to the next level.

Makary MA.

Source

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. mmakary1@jhmi.edu