LIJ Medical Center Introduces Video Monitoring Project to

Enhance Patient Safety in ORs

Once mainly an instrument to protect your belongings and family, cameras have expanded beyond homes and offices
into an area where a mistake can mean the difference between life and death: operating rooms. Long Island Jewish
(LIJ) Medical Center has installed cameras in all 24 of its operating rooms (ORs), which performed nearly 20,000
surgeries in 2013.
With the national average of approximately 40 wrong-site surgeries and about a dozen retained surgical objects left in
patients every week, the new pilot program at LIJ strengthens patient safety by providing hospitals with real-time
feedback in their ORs. LIJ and the North Shore-LIJ Health System's Forest Hills Hospital are the only hospitals in the
country using remote video auditing (RVA) in a surgical setting, working with Arrowsight Inc.
RVA ensures that surgical teams take a "timeout" before they begin a procedure. The team then goes through a
patient safety checklist aimed at avoiding mistakes. Each OR is monitored remotely once every two minutes to
determine the live status of the procedure, and ensure that surgical teams identify and evaluate key safety measures
designed to prevent "never events," such as wrong-site surgeries and medical items inadvertently left in patients. The
cameras also are used to alert hospital cleaning crews when a surgery is nearing completion, which helps to reduce
the time it takes to prepare the OR for the next case. To reduce the risk of infections, the monitoring system also
confirms whether ORs have been cleaned thoroughly and properly overnight. In a matter of weeks, patient safety
measures at both hospitals improved to nearly perfect scores.
"Within weeks of the cameras' introduction into the ORs, the patient safety measures, sign-ins, time-outs, sign-outs,
as well as terminal cleanings all improved to nearly 100 percent," says Chantal Weinhold, executive director of LIJ. "A
culture of safety and trust is palpable among the surgical team."
Additionally, all staff can see real-time OR status updates and performance feedback metrics on plasma screens
throughout the OR and on smart-phone devices.
The program was designed and implemented by North Shore-LIJ's anesthesiology provider, North American Partners
(NAPA), in partnership with Mount Kisco, NY-based Arrowsight, Inc., a developer and third-party provider of RVA
services and software.
"At a time when healthcare reform plays a significant role in all that we do, it is important to engage the full spectrum
of stakeholders to improve how safely and efficiently we deliver healthcare to our patients," says John F. Di Capua,
chair of anesthesiology for the North Shore-LIJ Health System and chief executive officer of North American Partners
in Anesthesia.
The introduction of video monitoring in ORs follows its ongoing, successful use in the medical and surgical intensive
care units at North Shore University Hospital. In a 2011 study published in Clinical Infectious Diseases Medical
Journal, NSUH demonstrated that the use of Arrowsight's third-party RVA system rapidly improved and sustained
hand hygiene rates to nearly 90 percent in less than four weeks.
"The recognition and expansion of Arrowsight's RVA technology is a validater for us, showing firsthand what the RVA
system has done to improve patient safety and efficiency at North Shore LIJ Health System, not just in the ICU's but
now in the surgical department," says Adam Aronson, Arrowsight's chief executive officer.
Source: North Shore-Long Island Jewish Health System


Wiping Is as Effective as Suctioning in the Delivery
Room
Robin Steinhorn, MD reviewing Kelleher J et al. Lancet 2013 Jul 27.
In low-risk newborns, wiping the nose and mouth is as effective as bulb suctioning to clear the oropharynx of secretions.
The current Neonatal Resuscitation Program (NRP) guidelines indicate that nasal or oral suctioning of healthy neonates is not
required after delivery and that these interventions should be reserved for infants with obvious obstruction to spontaneous
breathing. In addition, small trials have shown that suctioning of the mouth and nose is not necessarily a benign practice and can
lead to complications such as bradycardia and apnea.
In a randomized study involving 506 low-risk neonates, investigators at the University of Alabama compared routine wiping
versus suctioning with a bulb syringe in the delivery room. Infants with depressed muscle tone or respiration or meconium-
stained amniotic fluid were excluded.

The primary endpoint of respiratory rate at 24 hours after birth was equivalent between the wipe and suction groups (51 and 50
breaths per minute, respectively). Secondary outcomes of Apgar score, need for advanced resuscitation, and tachypnea were also
similar between the two groups. A nonsignificant trend toward higher admission rates to the neonatal intensive care unit was
noted in the wipe group (18% vs. 12%; P=0.07).

COMMENT
These findings confirm the Neonatal Resuscitation Program guideline stating that routine wiping of the nose and mouth is as
effective as bulb suctioning to clear the oropharynx of secretions in the delivery room. In this study, infants were low risk; most
were already vigorous and may not have required suctioning or wiping to initiate breathing. Wiping avoids the risks for
bradycardia and injury from more invasive suctioning and can be easily used in resource-limited settings.
Dr. Steinhorn is Professor and Chair of Pediatrics, University of California Davis Medical Center, Sacramento.
CITATION(S):
1. Kelleher J et al. Oronasopharyngeal suction versus wiping of the mouth and nose at birth: A randomised equivalency
trial. Lancet 2013 Jul 27; 382:326. (http://dx.doi.org/10.1016/S0140-6736(13)60775-8)
- See more at: http://www.jwatch.org/na31833/2013/08/20/wiping-effective-suctioning-delivery-
room#sthash.Kf3rapTU.dpuf