Is video observation as effective as live observation in improving teamwork in the operating room?

Teamwork in the operating room decreases the risk of preventable patient harm. Observation in the operating room allows for evaluation of compliance with best-practice surgical guidelines. This study examines the relative ability of video and live observation to promote operating room teamwork.Video and audio cameras were installed in 2014 into all operating rooms at an 875-bed, urban teaching hospital. Recordings were chosen at random for review by an internal quality improvement team. Concurrently, live observers were deployed into a random selection of operations. A customized tool was used to evaluate compliance to TeamSTEPPS skills during surgical briefs and debriefs.A total of 1,410 briefs were evaluated: 325 (23%) through live observation and 1,085 (77%) through video; 1,398 debriefs were evaluated: 166 (12%) live and 1,232 (88%) video. For briefs, greater compliance was observed under live observation compared to video for recognition of team membership (87% vs 44%, P.001), anticipation of complex procedural events (61% vs 45%, P.001), and monitoring of resources (58% vs 42%, P.001). For debriefs, greater compliance was observed under live observation for determination of team structure (90% vs 60%, P.001), establishment of a leader (70% vs 51%, P.001), postoperative planning (77% vs 48%, P.001), case review and feedback (49% vs 33%, P.001), team engagement (64% vs 41%, P.001), and check back (61% vs 46%, P.001) compared to video.Video observations may not be as effective as evaluating live performance in promoting teamwork in the OR. Live observation enables immediate feedback, which may improve behavior and decrease barriers to compliance with surgical safety practices.