Any surgical procedure that employs a scope can be documented on video. Physicians performing gastrointestinal and laparoscopic surgery, spinal and neurological procedures, ophthalmology and ENT cases all view a large part of the action through a lens, be it an endoscope's camera head or a microscope's optics. But can video documentation really attract surgeons to your facility and keep them scheduling cases in your ORs? Perhaps. As you'll see, not everyone's recording their cases, but the idea does have some allure to physicians.

The magic of moving pictures
Tammy Baergen, RN, CNOR, director of perioperative services at Harris Methodist Southwest Hospital in Fort Worth, Texas, says she's seen it draw orthopedic and laparoscopic surgeons. "They know that when they come in, we're going to have the latest and greatest in video technology," she says.

"It can be a marketing tool for administrators," says Steven D. Vold, MD, the CEO of Boozman-Hof Regional Eye Clinic in Rogers, Ark. "For me it would be." Dr. Vold notes that video documentation is something he requested upon his arrival at the clinic. "A quality system can build up the reputation of a practice or an ASC," he says.

Don't underestimate the value of moving pictures in explaining surgery to your patients, says Ms. Baergen. "With video, we're showing what an injury like yours looks like from the inside out, and how we're going to fix it."

"For me, the predominant reason [to record cases] is education," says Dr. Vold. "It's one thing to tell patients about surgery, but it's another to show them. And patients are interested in watching. It's a very impressive thing."

The captured visuals also lend patients confidence in the procedures they are scheduled to undergo or have recently undergone, he says. "It adds a level of transparency. They really believe you are giving them the highest quality of care."

Video can provide a thorough record of a patient's case for later reference. "How much better to have a video of the surgery than an operative note? And you don't have to dictate anything," says Mark Packer, MD, FACS, a clinical associate professor at Oregon Health and Science University and an ophthalmologist in the practice of Drs. Fine, Hoffman and Packer in Eugene, Ore., who records cataract, refractive and glaucoma surgeries. "As electronic medical records continue to make inroads, this kind of documentation will become more common, perhaps even a standard of care." He foresees cases digitally archived on a facility's server and linked to a patient's electronic file, perhaps accessible from a surgeon's office or home computer as well.

This might, however, prove to be a double-edged sword, says Ms. Baergen. "There's the legal aspect. We're not yet at the point where we're required to record everything to make sure we've done everything right," or to fulfill insurance requirements, she says. "I don't want to see it get to that point."

At Harris Methodist, where some laparoscopic procedures are performed with the assistance of a surgical robot, video also offers a way to introduce robotic surgery to the public.

"It presents the procedure in a gentler way," says Ms. Baergen. "It shows the finesse and intricacy of robot-assisted laparoscopic work. You don't have to be afraid of having your procedure done by a robot."

As robotic surgery finds more applications, video documentation will play a large role in promoting them to patients as well as surgeons, she anticipates.

Self-help
Clinical education is another frequently cited use for video documentation. Training OR nurses and other staff on new procedures and techniques is one option, but Dr. Packer highlights the rich possibilities in surgeons improving their own skills, too.

"The vast majority of cataract surgeons don't record their cases, and many don't want to," he says. "They end up doing things the same way every time, because they're not able to observe their own technique."

They should take heed of the technology's potential for physician self-improvement, says Dr. Packer, who counts it among the leading reasons he records his cases. "You cannot make advances in what you're doing unless you take time to learn from it," he says, "and you can only learn for yourself what you do by watching."

He adds that surgeons who improve their skills also improve a facility's patient care. "The real value is improved outcomes," he says. "That's the total quality improvement. You'll find surgeons enthusiastic and satisfied, striving for the best possible result. There is a real tangible value here."

On a larger scale, video documentation can help surgeons raise their peers' performance as well. New approaches or techniques can be presented from the podium at conferences or uploaded to the increasing number of clinical Web sites featuring surgical footage. In the latter option, says Dr. Vold, "You have worldwide reach. [For the viewer,] it's almost like being there. It's a lot easier to see someone's work online than to go visit their practice."

System in action
"I document every case that I do," says Dr. Packer. "I don't save them all, but you never know when something interesting is going to happen."

He records procedures to mini DV (digital video) tapes, uploading the footage through his computer to the server and reusing the tapes. He says he intends to upgrade his system next year from the videotape recorder to a digital camera that will record directly to the server.

"About one out of 20 cases I end up saving," he says. "Those would be cases so smooth and perfect that it's a great illustration of technique, or difficult cases with challenges and complications that make interesting teaching."

Ms. Baergen recalls that when her hospital first installed video documentation equipment in the early 1990s, the surgeons performing laparoscopic procedures videotaped nearly everything due to its novelty. While the facility's adopted digital technology by now, she says, "the doctors are selective. They only record abnormal or uncommon diagnoses." Still images are uploaded to the hospital's servers for electronic medical records, as are an endoscopic ultrasound system's output, but surgeons who want to record, review or edit a large amount of surgical video take it along with them on a multimedia card.

If your OR is wired for video recording, says Dr. Vold, then it's also possible to channel the live video signal to a monitor in another OR, an on-site office or a family waiting room to keep interested parties up-to-date on the progress of a case.

Service and training
When it's time to trial the equipment, vendors' reps will bring the system components to your ORs, but Ms. Baergen warns you to exercise caution. "Make sure they bring the equipment that you're considering," she says, and not pricier models or more extensive systems that may attract physician interest during test drives.

"We had a side-by-side comparison of three vendors' products, reviewing the different features on each," she adds. "You can drive down pricing by doing your evaluation in a competitive way like that."

As with any technology purchase, customer service should factor significantly into your choice, she says. "Whether we're talking about the vendor's rep educating your staff and sitting in to observe procedures, or warranty and repair, or a loaner exchange, you want responsiveness you can rely on."

If you and your surgeons are considering video documentation, you've probably come to grips with spending the money. But are you prepared to spend the time it'll take to learn the system to reap the best results?

From a practical standpoint, that means that your OR staff may have to learn to make the system work in the clutch. "Technology is either a wonderful thing or a headache," says Ms. Baergen. "You can have the best available equipment but still have glitches." While technicians can be called for repairs, in the immediate situation, troubleshooting is the nurse's job.

In addition, videos don't shoot themselves. Assistants, or assistance, may be needed. "The microscope's view is wider than the view recorded by the camera," says Dr. Packer. "Someone's got to pay attention to make sure the eye is centered in the screen." Keep in mind, too, that no one presents raw video footage at conferences, so your physicians will need to work with videographers or learn to edit. "At conferences, you see some that are awful and some that are astonishing," he says. "How much time do you want to spend on yours?"