Learning from Video Recordings to Help Save Lives

Let’s go to the videotape,” is a popular television sportscaster refrain that took on new meaning for the Trauma Services team at UPMC Williamsport in January of this year. That’s because of a video recording system made possible through a donation from the William P. and Lorraine Manos Foundation. This technology will enable health care teams to evaluate what happens in the emergency room trauma bays after resuscitations occur, allowing them to make critical improvements to processes and procedures. This will lead to quality initiatives that will foster better patient outcomes.

This video technology is an invaluable educational opportunity for trauma teams, who are rarely afforded a chance to carefully observe the overall process in real-time while they are treating a patient. “Trauma is unpredictable and chaotic in the moment that we are treating,” says Ronen Elefant, MD, MBA, FACS, medical director, Trauma Services, and chief, Acute Care, UPMC in North Central Pa. “With the surveillance camera system, we get a chance to go back and see what happened during those intense moments. We can get a bird’s-eye view of how things unfolded and learn so many valuable things.” Evaluating actual patient resuscitations after an event allows Dr. Elefant and his team to promote:

• High-quality care

• Educational opportunities

• Critical thinking skills

• Adherence to practice management guidelines and trauma protocols

• Updates to protocols and guidelines based on evidence-based trauma care

All this will facilitate continuous performance improvements that will benefit patients and their families in the relatively new trauma center of UPMC Williamsport.

Wagner and Elefant

Bringing Trauma Video Surveillance Technology to UPMC Williamsport

UPMC Williamsport initiated the process to become a designated Trauma Center and earned Level II Trauma Center accreditation from the Pennsylvania Trauma Systems Foundation in September 2021. In its short history, patient volume has increased by more than 32%, serving more than 5,200 patients. Responding to a real need in the region, Level II designation signifies that the hospital’s standards for timely and quality trauma care are among the highest in the United States.

The Trauma Center serves 12 counties in north central Pennsylvania, which span 2,500 square miles. This degree of trauma care is a vital resource to have in the region, with the next closest trauma center located 45 minutes away from Williamsport, in Danville.

Dr. Elefant was a part of the rigorous process to bring this Level II designation to UPMC Williamsport, and he is very pleased that the Trauma Center was gifted the surveillance video system. “This equipment benefits the whole medical system here. Every unit and department stands to gain from the metrics we are able to collect,” he says. “Very few trauma centers have this advanced technology, and we are lucky to have community donors appreciate its importance.”

Every Second Counts

When in the midst of a chaotic, high-paced resuscitation, trauma team members work at incredible speeds with well-choreographed intensity. A split second taken to look around and observe the details can impede their work to save lives. But remembering all those details afterward might not be easy. The video system, activated upon the patient’s arrival, allows the trauma service and emergency room staff a second chance to audit and assess processes and mechanisms after the fact.

The multidisciplinary team of experts available around the clock is prepared for the unexpected, and every role counts. Being able to go through the play-byplay of a resuscitation to determine what is working well (and what is not) weighs the scale toward improved outcomes, according to Krysta Wagner, MBA, director, Operations for Emergency Services, Trauma, and Acute Care, UPMC in North Central Pa.

How It Works

"Williamsport is just the third UPMC trauma center to have a trauma video system installed, with the first two being Children’s Hospital of Pittsburgh and UPMC Mercy, also in Pittsburgh. Each trauma bay uses two live-capture cameras and speakers to record resuscitations," says Krysta. After a resuscitation, only those with surveillance privileges review the footage, looking for adherence to protocols, evidence-based practices, and opportunities to improve assignments and safety. They are looking for things that they can adjust, add, or otherwise improve moving forward, raising questions such as:

• Was the workup of the patient done in an appropriate manner?

• Should any additional interventions have been done prior to leaving the trauma bay?

• Was any unnecessary time spent in the trauma bay?

Why It Works

Surveillance video auditing has shown that trauma centers are able to manage resources appropriately, learn, and educate step-by-step. The technology can also help reduce the time taken:

• For resuscitation overall

• To get a patient a CT scan

• To get a patient into an operating room

• To get a patient to the point of emergency room discharge

Reducing the time taken for these types of procedures without diminishing the level of care helps improve survival rates, particularly for the most severely injured patients. This is true both from within and from outside of a dedicated trauma center," says Dr. Elefant.

Trauma team performance can be enhanced through the auditing and assessment of video. “To be clear, this is not a tool to grade individual performance or for any kind of punitive purposes,” says Dr. Elefant. “To the contrary, the video system is used to help improve how we support our team to ensure the best possible patient outcomes and consistent processes.” Leadership skills are honed through understanding all the facets of what occurs in the moment of a resuscitation. “Being able to observe technical and nontechnical skills has been shown to be particularly important,” Dr. Elefant notes.

According to Krysta, current evidence suggests that video recording of trauma resuscitations has great merit with respect to the education of health care providers, clinical research, and quality improvement. “This video recording tool offers a unique environment for the future education of trauma team staff,” she notes. The system will allow team members within Emergency and Trauma Services to promote high-quality care, education, and critical thinking skills. Additionally, it will positively impact future practice management guidelines and trauma protocols, promoting evidence-based best practices in the treatment of traumatically injured patients.

Before becoming a Level II Trauma Center, about 40% of patients had to transfer to another health care facility to get the care they needed, says Krysta. “Today, transfers are infrequent because UPMC has expanded to a tertiary center where patients can obtain the care they need close to home.” The video recording system has a far-reaching impact on those specialties that support the Level II Trauma Center as well, providing data to support improved handoffs and preparedness.

Always Confidential and Private

Dr. Elefant emphasizes that the video recordings are only reviewed by those with surveillance privileges and are not used for any type of employee evaluations. Neither are they available to anyone outside of the reviewers. The video is not available for educational courses, not for staff or patients, not for insurance companies or administrators, and not for legal professionals. “We take privacy, confidentiality, and HIPAA laws very seriously, even within our own system,” says Krysta. “When the review is done, the videos are erased.”

Krysta says that the video surveillance equipment was a vision of the Trauma Center that the Foundation championed, connecting them with generous donors who understood the needs of this type of emergency care.

“The Foundation was a matchmaker, connecting our trauma center with donors whose support resonates with their values or personal experiences,” says Krysta. “We are going to save more lives, improve more lives, from what we learn from the video recording program. It’s rewarding.”

What Is Trauma Resuscitation?

When patients come to the trauma center, they are experiencing an extreme health emergency. Trauma resuscitation is the act of correcting the physiological dysfunction a patient experiences through some form of trauma. Resuscitation is an essential function in emergency departments, intensive care units, and trauma surgery.

Common incidents that lead to trauma resuscitations in the UPMC Williamsport Trauma Center include motor vehicle accidents, falls, and blunt-force injuries, according to Dr. Elefant and Krysta.

Because trauma resuscitations are by nature resource-intensive and time-pressured occurrences, medical institutions can benefit greatly from video recording systems that allow them to analyze, collect data, and improve how they treat patients in the critical moments of trauma treatment.