There are many potential uses of video technology in the operating room; however, few have been implemented. Uses include using video for teaching best practice, monitoring team performance, skills training and operating room command and control . We wish to report an innovative use of two iPod Touch™ devices (Apple, Cupertino, CA, USA) in the operating room environment that we believe have the potential to improve patient safety.
The latest (4th generation) Apple iPod Touch has two built-in high definition cameras. There is a feature built into the device, called FaceTime™, that allows the devices to be used for live video-conferences. Each party can decide to use either the front-facing or rear-facing cameras, depending on what image they wish to show. The devices do not use a conventional phone signal to carry the FaceTime transmission, rather they use any local WiFi network, which is often present in healthcare facilities.
An iPod Touch was mounted on a GorillaPodTM flexible tripod (Joby, San Francisco, CA, USA) using velcro. The tripod was wrapped around a standard intravenous pole mount. The rear-facing camera was pointed to a ‘patient’ monitor (we used a simulated patient to avoid transferring patient data over an unsecured internal network; Fig. 2). A FaceTime connection was established between the two devices. The second device was at a remote location within the same theatre suite (Fig. 3), but could have functioned identically anywhere else in the hospital. The ‘patient’ data were displayed on the second iPod Touch that was secured under a second ‘patient’ monitor. The patient in this case was one of the authors. We found the quality of the video display of the iPod Touch to be acceptable for viewing the vital signs of our simulated patient. There was no perceptible lag, although data transfer rates were not formally measured. The audio quality was also found to be acceptable; a conversation could be held at normal volumes. Our second test involved remote monitoring of a simulated infant undergoing tracheal intubation, and again we found the quality of both video and audio to be acceptable.
Remote supervision is routinely practiced in anaesthesia worldwide. In the UK, consultants provide junior anaesthetists with either local or distant supervision. In the USA model, one attending anaesthetist may be supervising multiple theatres, but needs to maintain situational awareness in order to be able to plan multiple operating lists. We have described an effective and relatively cheap method to conduct videoconferences in the theatre environment (iPod Touch $229, Gorillapod $30, Superglue $1.50, ¼ inch nut $0.25 and zero ongoing costs).
One of the advantages of this setup is the use of a completely mobile device. The remote iPod Touch can easily be carried from location to location allowing constant situational awareness of the case in progress. As FaceTime includes video and audio, it would be easy to discuss in real time any important changes occurring during a case. Furthermore, the local iPod Touch could easily be redirected to display other pertinent information. Traditional data networks involve more ‘hardwired’ connections with less mobility and often require IT support. They also use more expensive equipment. Although this is not a substitute for an anaesthetist’s presence during a case, such a system could prove beneficial during cases without constant senior presence, thus improving supervision levels, coordination of patient flow and ultimately patient safety.