3.1 Safe

Practical guidance

Securing consent: a crucial step for video review in healthcare

Consent is the foundation of ethical video review in healthcare. However, procedures for obtaining consent can vary significantly between hospitals, both within and across countries.

Understanding your institution's rules:

Before implementing video review, familiarizing yourself with your hospital's policies is crucial. These policies typically address obtaining and documenting informed consent from patients and staff regarding:

• Recording procedures

• Data storage and access

• Video usage for educational, research or quality improvement purposes

Understanding these policies ensures your video review initiative adheres to best practices and aligns with your institution's legal and ethical frameworks.

Where to find them:

• Hospital intranet or policy manuals

• Human Resources department

• Risk Management or Legal department

• Department heads or supervisors

Consider the following questions:

Patient consent

• Informed consent: Detailed procedures for obtaining and documenting patient consent for recording, storage, and use of their medical data, including video.

• Privacy and confidentiality: Strict guidelines aligned with HIPAA (or relevant regulations in your region) on protecting patient information, restricting access to video footage, and secure storage measures.

• Patient rights: Policies outlining patient rights in relation to video review, such as the right to refuse recording, access their recordings, or request changes.

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

• Consent for recording: Procedures for obtaining staff consent before, during, and after recording procedures. This might include opt-in systems and the right to withdraw consent at any time.

• Video usage: Clear definition of allowable purposes for video recording and review (quality improvement, education, etc.). Explicit prohibition of using footage for punitive measures.

• Professional conduct: Expectations for staff behavior during recordings to ensure respectful and appropriate interactions.

• When and how are providers informed?

• Should providers explicitly consent?

• Can individual providers refuse recording or reviewing?

The Neoflix approach recommends you to use a triple consent procedure.

Additional considerations

• Medico-legal: Procedures for handling video recordings in the event of adverse incidents or legal claims, including potential obligations to retain footage.

• Research: Specific policies if video recordings are to be used for research purposes. These might include additional approval processes and ethical considerations.

Consent procedures may differ between hospitals, both nationally and internationally. Click here for different consent approaches from NICU's who have implemented video review successfully.

Implementing a triple consent procedure in your video review program establishes multiple layers of respect and autonomy for providers. This builds trust and empowers them, increasing their willingness to participate. The ability to withdraw consent at any time reduces anxiety and fosters a positive learning environment. The focus on consent also encourages open communication, leading to greater collaboration and better overall outcomes.

Not asking for consent in your video review program undermines trust and erodes provider autonomy. This can lead to resistance, resentment, and a decreased willingness to participate, limiting the potential for learning and improvement. Providers may feel anxious or concerned that their work could be used without their knowledge or approval, hindering a positive learning environment. The lack of open communication about the process could lead to misunderstandings, further damaging trust and potentially compromising the entire program's success.