Contentious issues that require resolution prior to successful emergency department VAR programme implementation
| Statement | Supporting argument(s) | Counterargument(s) | Relevant sources |
| Patient consent is required for VAR data collection for QI purposes. | VAR in resuscitation likely poses ‘more than minimal risk’ to the patient. VAR data involve collection of private information. VAR data involve collection of PHI for a primary purpose other than direct clinical care. | Use of collected PHI for QI purposes does not require patient consent. Consent in resuscitative situations is impractical. Participation in healthcare QI is generally in the patient’s interest and is less risky than altering the healthcare system without evaluation. Efficacy of QI initiatives requires participation of all eligible patients. Notice, subsequent opportunity to withdraw data from QI analysis and robust data security safeguards are possible substitutes for patient consent. | 19 21 22 24 25 35 |
| Healthcare provider consent is required for VAR data collection for QI purposes. | VAR data constitute collection of private information given the provider(s) is/are able to be identified. This may pose ‘more than minimal risk’ to providers. | Participation in QI initiatives is an expectation of employment. Video recording is commonplace in public spaces, including hospitals. | 21 25 26 |
| VAR data should be part of the patient’s chart. | VAR data offer supportive evidence in the case of medicolegal action. | If patient encounter is otherwise documented to agreed on standards, VAR need not be included in the patient record. This offers stricter control over VAR data, with shorter retention requirements to improve data security. VAR data may be considered confidential, under quality assurance privilege. | 22 28 29 35, Canadian Medical Protective Association (personal communication, 2019) |
| VAR data should be used for physician evaluation. | VAR offers rich opportunity for feedback and improvement if feedback presented in constructive fashion. | Physicians have the concern of being ‘too exposed’. Healthcare providers will only accept VAR if the objective is system improvement, and not for individual punitive assessment. | 25 32 33 |
PHI, personal health information; QI, quality improvement; VAR, video and audio recording.