NICU in Philadelphia, Pennsylvania, USA

The Hospital of the University of Pennsylvania, Level III NICU and the Children's Hospital of Philadelphia, Level IV NICU implemented video recording and review of neonatal procedures in their unit. Heidi Herrick and Liz Foglia oversee the ongoing program. We will dive into their set-up and lessons learned. You will also find some contact details if you have any other questions for this center.

The Hospital of the University of Pennsylvania, Level III NICU

Recording Setup

• Fixed cameras are used in the delivery room.

• Mobile and eye-tracking devices are used in the unit.

• In the resuscitation room, there is a bird’s-eye view of the bed, a C-section room view, a wide-angle camera, and a recording of the monitor with audio.

• Livecapture and Tobii Pro II (mobile and eye-tracking, with audio) are used as devices.

• Patient and provider identification is visible.

Consent

• Parental consent is obtained with admission consent, and there is an option to opt-out. No additional consent is needed for internal review. Videos are deleted after 28 days unless further consent is obtained for post-28 day use or external education.

• Providers are informed of video use, and no consent is required for recording, review, quality improvement, or research. Consent is needed for external education.

Video Use

• Videos are not shown to parents.

• Providers can review videos individually or participate in facilitated review sessions.

• Videos are not part of the medical record.

• Videos are used for quality assurance, quality improvement, education, and research.

Video Review

• Fellows conduct unit-wide video review six times a year.

• Video review is used for clinical purposes and targeted quality improvement projects.

Storage

• Videos are stored on a secure server accessible when in the hospital or via remote desktop access.

• All NICU providers have access.

Children's Hospital of Philadelphia: Level IV NICU

Type of recording

• Dedicated resuscitation rooms: we have a birds-eye of the bed, a wide angle, and a video feed of the monitor. The wide angle captures providers faces so is identifiable. Audio is included

• Equipment: LiveCapture

Patient consent

• Parental consent is obtained as part of the admission consent for treatment, with the option to opt-out.

• Videos are deleted after 45 days, not part of the medical record of the patient.

• If they want to use a video after 45 days, extra consent is obtained.

Storage

• Videos are stored on a secure server that requires login. Only providers given permission by the audiovisual committee can access the videos.

If you have any questions, regarding this approach, feel free to contact this experienced center at [e-mail]

Pros

• The multidisciplinary video review sessions have been extremely well attended and are facilitating conversation across professions.

Cons

• The biggest issue in the HUP is missing the beginning of unexpected, acute resuscitations, providers forgetting to press the start button of the recording equipment, or providers ending the video early. This is rare but does sometimes happen.

• Video review is time consuming

• The mobile set-up is challenging to get into place quickly and sometimes doesn't give a good view.

• Eye-tracking is time-consuming to set up and to analyze.