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.