140 Use of GoPro to Assess Central Venous Line Placement Competency Asynchronously

Abstract

Complications due to failed central venous access (CVA) attempts are associated with increased morbidity and health care costs. The Agency for Healthcare Research and Quality (AHRQ) estimates a central line associated blood stream infection (CLABSI) costs approximately $70,000. There is a high failure rate in completing ultrasound guided central venous access (UGCVA) procedures among first year resident interns. Training and assessment is important, however physician time to assess resident competency is limited. Previous research has demonstrated that a GoPro camera can be used to capture procedures. In this research, we will evaluate the use of video recordings to asynchronously evaluate resident procedural competency in ultrasound guided central venous line (USGCVL) placement. This research had several steps. First, we evaluated the ability of GoPro cameras to capture procedural competencies during USGCVL procedures. Next, we developed and validated an evaluation rubric consisting of critical competencies identified from the literature and institutional guidelines. Faculty reviewers evaluated the GoPro videos asynchronously for visual clarity, and completeness of observation while using the rubric. Results demonstrated high agreement between reviewers (80-100%) for visualization of each competency. Residents were recruited to participate in this study during a training course designed to assess procedural competency in central line placement using a cadaver. Following consent, participants donned a head-mounted GoPro camera to record their performance. During the procedure, faculty evaluated residents' performance synchronously (via Qualtrics) using the same evaluation rubric validated in the prior study. At a later date, two teams each composed of a surgeon and emergency medicine (EM) physician (different than the synchronous reviewers) asynchronously viewed and independently evaluated videos divided into groups of four using the same rubric via Qualtrics. Inter-rater reliability was calculated between pairs of asynchronous reviewers and average percent agreement was calculated for both the asynchronous and the asynchronous versus live reviews. Video recordings of twenty-eight USGCVL procedures were collected. Twenty-four met study inclusion criteria (1080p 30fps continuous video no significant glare, no gross misalignment of the video field of view) and twenty are included in the data analysis. (Four videos have not been reviewed by their assigned reviewers yet.) Results are presented in Table 1. Overall percent agreement approached 80% for both asynchronous and asynchronous versus live comparisons. This study supports the feasibility of using a head mounted GoPro camera to record video for asynchronous evaluation of resident USGCVL placement. Continued refinement of data capture, scoring practices, and the grading rubric is needed to increase both the validity and reliability of the assessment process.Table 1Average percent agreement.Average Percent Agreement (%)95% CI (%)Asynchronous Rater Comparison 12 VideosRater 2 (surgeon) vs. Rater 3 (EM)73.4744.04100Live Graders vs. Asynchronous 8 VideosRater 1, 3 (EM) vs. live graders78.1242.54100 Open table in a new tab