As part of his efforts to educate the public about heart health, Frederick Meadors, MD, a surgeon at St. Vincent Infirmary Medical Center in Little Rock, AR, had planned to perform surgery on a patient while 330 people watched the procedure live through a video feed in a hospital auditorium.
However, that plan was scuttled when Meadors' professional group, the Society of Thoracic Surgeons, announced recently that such broadcasts no longer are considered acceptable. The hospital had put six months into planning the event, but officials confirm that the plan was changed abruptly in response to the society's move. Instead of watching the surgery live, the group watched a videotape of a surgery as Meadors explained it in person.
Live surgery broadcasts have grown in popularity in recent years, due partly to technological advances such as in-light cameras that make them relatively easy to produce. The cameras add about $12,000-$30,000 to the cost of each light, and most ORs use at least two lights, according to sources.
The public's fascination with medical procedures that, in previous years, might have been considered unpleasant to watch also has been growing. But some surgeons and surgical groups are expressing concern that having a surgeon perform live for an audience isn't such a great idea.
In 2006, the American College of Surgeons in Chicago banned live surgery broadcasts at its meetings. "The safety and welfare of patients is the foremost consideration for all involved in health care," the college said. "Live televised surgery is viewed as essentially weighing the benefits to surgeons with the possibility of increased risk to patients. Given the lack of substantive data regarding these areas, the decision was made that safety and the interest of patients must take precedence." Use of videotaped procedures was permitted and encouraged.
Earlier this year, the Society of Thoracic Surgeons also banned live surgery broadcasts at its meeting, but it went a step further by saying that its members should not perform live surgery broadcasts to the general public because they may be distracted from their primary duty to the patient, explains Robert A. Wynbrandt, JD, executive director and general counsel of the society. The society's board of directors is approving a more extensive policy that addresses a wide range of ways in which surgery may be viewed by others, he says. It includes everything from having residents standing nearby to participating in live television shows. At press time, that policy had not been published, but it was expected soon.
"The tricky thing is that there is no empirical data to base these decisions on. There are no studies that have shown it is risky or not risky to have the surgery broadcast live," Wynbrandt says. "You hear anecdotal evidence about mishaps that people have had during live surgery, but nothing documented. So we have to base our policies on what is good for the patient and where our priorities should be."
Worries about distracted surgeons
The basic concern is that the surgeon's attention will be divided by having to perform for the camera and narrate what he or she is doing, and that this scenario would compromise patient safety, Wynbrandt says. That risk is only theoretical, he notes, and many surgeons argue that they are adept at multitasking. Their attention is divided already, they say, and having a camera in the room does not create any extra risk. Wynbrandt says the society can't prove otherwise but would rather err on the side of patient safety.
Others look at the issue of broadcasting surgery differently. "Many surgeons are very comfortable teaching and operating at the same time," says C. Lowry Barnes, MD, president of Arkansas Specialty Orthopaedics, St. Vincent Infirmary, also in Little Rock. "Some might suggest that a surgeon might even be more 'careful' or 'safe' if being viewed by others." In fact, St. Vincent had broadcast a live surgical procedure to a group of attorneys, including plaintiff's attorneys.
There is considerable concern that live surgery broadcasts can increase the liability risk for surgeons and hospitals, but Wynbrandt says that still is only a theoretical risk with no cases to show any certain threat.
To avoid potential problems, consider these suggestions:
• Consider taping surgical procedures for broadcast.
Steven D. Schwaitzberg, MD, FACS, chief of surgery for Cambridge Health Alliance, says in terms of broadcasting live surgery, "I think there are inherent problems if things do not go well."
St. Vincent had broadcast live orthopedic and cardiovascular procedures in the past, but has moved to more pre-taped procedures, says Jon Timmis, vice president and chief strategy officer. "We're evaluating the risk to the patient associated with doing live surgery and evaluating and risk differential between cardiac and orthopedic surgery," he says. "Live orthopedic surgery has been a lot more mainstream and more refined over the years than live cardiac surgery, which is still fairly progressive and the patient is in a more compromised state."
Switching to videotaped procedures, which is a "much more controlled setting," was more effective than trying to have the surgeons moderate while performing live surgery, he says. "Surgeons could be in the auditorium and speak through the surgery, rather that in the operating suite," Timmis says. "We don't think we lost anything by making that conversion." However, experts in risk management warn that even videotaped procedures carry some risks because there is a recording if anything goes wrong in the case.
• Do your research.
Visit a facility that has been broadcasting for a while, Barnes suggests.
Several items must be determined before you broadcast, says Brett M. Harnett, MS-IS, research assistant professor and associate director of experimental IT at the Center for Surgical Innovation, University of Cincinnati. University Hospital in Cincinnati has broadcast live procedures including laparoscopic gastric bypass, minimally invasive heart procedures, and lung/lobectomy to the public and primary physicians with Harnett's help.
"Know exactly why you are doing this, who your audience is, and how it will benefit the institution," he says.
If you are conducting the broadcast for the public, a webcast usually is the format, Harnett says. The advantage is that the broadcast can be sent to a large audience; however, the video is significantly compressed and is grainier.
Webcasts are one-directional, so to obtain feedback, you need a chat or e-mail function, plus a gatekeeper/moderator in the OR, Harnett says. "Point-to-point video conferences are easier because they are usually bidirectional," he adds.
• Consider doing the taping internally.
University Hospital has taped some procedures and has outsourced some. "Outside firms are very invasive and costly," he says. University Hospital spent about $120,000 for five broadcasts, with the tapes kept in archive for one year. When they have used an outside firm, the hospital did stipulate that the company had to create minimal distractions to the OR staff.
Your biggest challenge will be audio, due to high ambient noise in the OR, Harnett says. If your budget allows, use the services of an audio expert, he advises. Find an audiovisual (AV) expert in your area by doing a web search, or call a local university, Harnett suggests.
At a minimum, use a quality microphone that is wired. Wireless microphones magnify the interference, Harnett says. However, he admits surgeons don't like a wired microphone, although they often are tethered elsewhere.
Also, train the surgeon and the staff for doing a broadcast, he says. "In other words, keep the background chatter to a dull roar," he says.
• Pick the right team members.
Know your staff, Harnett emphasizes. "Some surgeons are very good in this scenario," he says. "Others are not."
The surgeon should be accustomed to teaching, Barnes says. Also, ensure the anesthesia staff is top notch, he says. The OR team should be one that is highly trained and "does the same thing day in and day out," Barnes says.
Additionally, have a moderator who understands the operation and can answer questions during the operations, he says. St. Vincent uses an advanced nurse practitioner who has worked with Barnes for 13 years.
• If you broadcast live surgery, have a plan for emergencies.
"Patient safety always comes first," Harnett says. The fact it is being sent out as a live feed is irrelevant, Harnett. However, he adds, "we did have a plan to cut the live broadcast in the event of an emergency — obviously."
When planning a broadcast, don't make a decision in isolation, Timmis suggests. Instead, work closely with your surgeons, he says. "If the physician is interested, make sure all the benefits and risks are fully understood," Timmis says.
Sources
For more information on live surgery broadcasts, contact:
- Brett M. Harnett, MS-IS, Research Assistant Professor, University of Cincinnati; Associate Director, Experimental IT, Center for Surgical Innovation, 231 Albert Sabin Way, MSB Suite 1466D, Cincinnati, OH 45267-0558. Telephone: (513) 558-3252. Fax: (513) 558-2026. E-mail: [email protected]. Web: surgery.uc.edu/csi.
- Robert A. Wynbrandt, JD, Executive Director and General Counsel, The Society of Thoracic Surgeons, Chicago. Telephone: (312) 202-5810. E-mail: [email protected].
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