Effect of Body-Worn Cameras on EMS Documentation Accuracy: A Pilot Study

Implementation of Body Worn Camera: Practical and Ethical Considerations

Body-worn cameras are increasingly being used as a violence prevention tool in inpatient mental health wards. However, there remains a limited understanding of this technology from an implementation perspective, such as protocols and best practice guidance if cameras are to be used in these settings. This study explores the perspectives of patients, mental health staff, and senior management to understand the practical and ethical issues related to the implementation of body-worn cameras. Semi-structured interviews (n = 64) with 24 patients, 25 staff from acute wards, six Mental Health Nursing Directors, and 9 community-based patients were conducted. Interviews were analysed using reflexive thematic analysis. Ethical approval was granted by the Health Research Authority. Findings from this study show that the implementation of BWC in healthcare settings requires careful consideration. The perspectives of patients and staff demonstrate the complex reality of implementation alongside the consideration of practical and ethical issues around implementation that are essential to ensures that wards recognise the need to assess their capacity to use the cameras in a way that is fair and consistent for all involved. The findings further highlight wider questions around power and autonomy in mental health care.

Using machine learning to predict subsequent events after EMS non-conveyance decisions

Background

Predictors of subsequent events after Emergency Medical Services (EMS) non-conveyance decisions are still unclear, though patient safety is the priority in prehospital emergency care. The aim of this study was to find out whether machine learning can be used in this context and to identify the predictors of subsequent events based on narrative texts of electronic patient care records (ePCR).

Methods

This was a prospective cohort study of EMS patients in Finland. The data was collected from three different regions between June 1 and November 30, 2018. Machine learning, in form of text classification, and manual evaluation were used to predict subsequent events from the clinical notes after a non-conveyance mission.

Results

FastText-model (AUC 0.654) performed best in prediction of subsequent events after EMS non-conveyance missions (n = 11,846). The model and manual analyses showed that many of the subsequent events were planned before, EMS guided the patients to visit primary health care facilities or ED next or following days after non-conveyance. The most frequent signs and symptoms as subsequent event predictors were musculoskeletal-, infection-related and non-specific complaints. 1 in 5 the EMS documentation was inadequate and many of these led to a subsequent event.

Conclusion

Machine learning can be used to predict subsequent events after EMS non-conveyance missions. From the patient safety perspective, it is notable that subsequent event does not necessarily mean that patient safety is compromised. There were a number of subsequent visits to primary health care or EDs, which were planned before by EMS. This demonstrates the appropriate use of limited resources to avoid unnecessary conveyance to the ED. However, further studies are needed without planned subsequent events to find out the harmful subsequent events, where EMS non-conveyance puts patient safety at risk.

What evidence supports the use of Body Worn Cameras in mental health inpatient wards? A systematic review and narrative synthesis of the effects of Body Worn Cameras in public sector services

Body-Worn-Cameras (BWCs) are being introduced into Mental Health Inpatient Units. At present, minimal evidence surrounding their use in a mental health environment exists. This review examined research on the uses of BWCs in public sector services including healthcare, public transportation, and law enforcement. All eligible studies included a visible BWC, recording on a continuous loop as the main intervention. The evidence base presented high levels of bias, highly varied camera protocols, and heterogeneity of outcome measurements. This review found there is limited evidence for the efficacy of BWCs to control and manage violence within mental health inpatient wards. The technology has shown to be effective in reducing the number of public complaints in a law enforcement setting, but it is unclear how this is achieved. It appears there may be potential beneficial uses and unintended consequences of BWCs yet to be explored by mental health services.

Measurement and monitoring patient safety in prehospital care: a systematic review

BACKGROUND

Prehospital care is potentially hazardous with the possibility for patients to experience an adverse event. However, as compared to secondary care, little is known about how patient safety is managed in prehospital care settings.

OBJECTIVES

The objectives of this systematic review were to identify and classify the methods of measuring and monitoring patient safety that have been used in prehospital care using the five dimensions of the Measuring and Monitoring Safety (MMS) framework and use this classification to identify where there are safety 'blind spots' and make recommendations for how these deficits could be addressed.

METHODS

Searches were conducted in January 2020, with no limit on publication year, using Medline, PsycInfo, CINAHL, Web of Science and Academic Search. Reference lists of included studies and existing related reviews were also screened. English-language, peer-reviewed studies concerned with measuring and monitoring safety in prehospital care were included. Two researchers independently extracted data from studies and applied a quality appraisal tool (the Quality Assessment Tool for Studies with Diverse Designs).

RESULTS

A total of 5301 studies were screened, with 52 included in the review. A total of 73% (38/52) of the studies assessed past harm, 25% (13/52) the reliability of safety critical processes, 1.9% (1/52) sensitivity to operations, 38.5% (20/52) anticipation and preparedness and 5.8% (3/52) integration and learning. A total of 67 methods for measuring and monitoring safety were used across the included studies. Of these methods, 38.8% (26/67) were surveys, 29.9% (20/67) were patient records reviews, 14.9% (10/67) were incident reporting systems, 11.9% (8/67) were interviews or focus groups and 4.5% (3/67) were checklists.

CONCLUSIONS

There is no single method of measuring and monitoring safety in prehospital care. Arguably, most safety monitoring systems have evolved, rather than been designed. This leads to safety blind spots in which information is lacking, as well as to redundancy and duplication of effort. It is suggested that the findings from this systematic review, informed by the MMS framework, can provide a structure for critically thinking about how safety is being measured and monitored in prehospital care. This will support the design of a safety surveillance system that provides a comprehensive understanding of what is being done well, where improvements should be made and whether safety interventions have had the desired effect.

Law and (rec)order: Updating memory for criminal events with body-worn cameras

Body-worn video is increasingly relied upon in the criminal justice system, however it is unclear how viewing chest-mounted video may affect a police officer's statement about an event. In the present study, we asked whether reviewing footage from an experienced event could shape an individual's statement, and if so, whether reporting before reviewing may preserve an officer's original experience. Student participants (n = 97) were equipped with chest-mounted cameras as they viewed a simulated theft in virtual reality. One week later, half of the participants recalled the event in an initial statement while the other half did not. Participants then viewed either their body-worn video or a control video. Finally, participants provided their statement (no initial statement condition) or were given the opportunity to amend their original account (initial statement condition). Results revealed that viewing body-worn video enhanced the completeness and accuracy of individuals' free recall statements. However, whilst reviewing footage enabled individuals to exclude errors they had written in their initial statements, they also excluded true details that were uncorroborated by the camera footage (i.e., details which individuals experienced, but that their camera did not record). Such camera conformity is discussed in light of the debate on when an officer should access their body-worn video during an investigation and the influence of post-event information on memory.

Cautionary study on the effects of pay for performance on quality of care: a pilot randomised controlled trial using standardised patients

BACKGROUND

Due to the difficulty of studying incentives in practice, there is limited empirical evidence of the full-impact pay-for-performance (P4P) incentive systems.

OBJECTIVE

To evaluate the impact of P4P in a controlled, simulated environment.

DESIGN

We employed a simulation-based randomised controlled trial with three standardised patients to assess advanced practice providers' performance. Each patient reflected one of the following: (A) indicated for P4P screenings, (B) too young for P4P screenings, or (C) indicated for P4P screenings, but screenings are unrelated to the reason for the visit. Indication was determined by the 2016 Centers for Medicare and Medicaid Services quality measures.

INTERVENTION

The P4P group was paid $150 and received a bonus of $10 for meeting each of five outcome measures (breast cancer, colorectal cancer, pneumococcal, tobacco use and depression screenings) for each of the three cases (max $300). The control group received $200.

SETTING

Learning resource centre.

PARTICIPANTS

35 advanced practice primary care providers (physician assistants and nurse practitioners) and 105 standardised patient encounters.

MEASUREMENTS

Adherence to incentivised outcome measures, interpersonal communication skills, standards of care, and misuse.

RESULTS

patient was more likely to be prescribed screenings not indicated, but highlighted by P4P: breast cancer screening (47% P4P vs 0% control, p<0.01) and colorectal cancer screening (24% P4P vs 0% control, p=0.03). The P4P group over-reported completion of incentivised measures resulting in overpayment (average of $9.02 per patient).

LIMITATIONS

A small sample size and limited variability in patient panel limit the generalisability of findings.

CONCLUSIONS

Our findings caution the adoption of P4P by highlighting the unintended consequences of the incentive system.

The use of body-worn cameras in pre-hospital resuscitation

Introduction:

Body-worn cameras (BWCs) are commonplace in many workplaces, but rare in the real-time audit of clinical performance in the pre-hospital setting. There are currently no data supporting the use of BWCs as an acceptable tool in clinical audit. Out-of-hospital cardiac arrest (OHCA) is a good candidate for audit – time critical, high stakes and not well observed. While the use of cameras to record such clinical data is demonstrably useful, it could be perceived by front line ambulance staff as intrusive and have a deleterious impact on clinical care. Investigating these potential barriers is important in ensuring that our effort to enhance the early phase of pre-hospital care through video audit does not have negative unintended consequences.

Methods:

Since 2012, the Resuscitation Research Group has used BWCs to provide a unique insight into how care is delivered by paramedics attending OHCAs. Paramedics attending arrests as part of the Resuscitation Rapid Response Unit (3RU) second-tier response wear a BWC, and collect real-time footage of these challenging, emotive clinical encounters. This footage has provided a unique medium for the audit of both individual technical task and team-oriented non-technical skills performance. We present the results of a survey in which paramedics share their views on the use of BWCs within their service.

Results:

A convenience sample of 83 questionnaires was collected. In relation to the primary outcome of the study, 81% (n = 53) of paramedics who responded to the statement, ‘the use of BWCs is a positive step for the service’, agreed or remained neutral, while only 19% (n = 12) disagreed.

Conclusion:

BWCs, and the supporting infrastructure and feedback processes, are an effective, acceptable and beneficial tool in the audit and analysis of team performance in pre-hospital resuscitation.