5. Limitations
Given the relative rarity of CA, the size of our sample is a limitation
to our study. Additionally, our study was a single-center at an academic
institution. The generalizability of the use of video review for quality
improvement is also a limitation. Video review proved to be a time
intensive endeavor. It required residents, in addition to their clinical
commitments, to be on call in order to check the EMR and capture the
video in time. Video capture had to occur in person in a narrow time
window of 72 hours due to medico-legal requirements. Furthermore, video
review time varied depending on the length of the resuscitation. The
person-hours required to review video doubled to ensure the consistency
between the reviews, requiring two residents to review each video.
However, it is worth noting that even in the absence of video review
capabilities, individualized and team-based feedback systems can, and
should, be implemented to enhance compliance with AHA metrics and
improve the quality of CA care in the emergency department. Such
feedback systems can be implemented at both large academic centers and
community sites through multiple means including but not limited to
video review. Only three resuscitation bays in our ED have video review
capability. Thus, the data set did not include resuscitations that
occurred in other rooms. At the time of this article, the COVID-19
pandemic has greatly affected both video-collection capabilities and
educational experience. Attempting to limit house staff exposure to the
hospital environment greatly reduced our ability to collect data.
Furthermore, CoVeRT educational experiences during Grand Rounds were
discontinued due to the constraints of video review over online video
conferencing platforms that are not HIPAA-compliant. Lastly, the
increased utilization of PAPRs and masks impaired the camera quality and
microphone sensitivity and has made certain communication inaudible.