Purpose of review <p>Trauma video review (TVR) has been used for education, quality improvement, and research of the injured patient for over 3 decades, but less work has been done to explore the application of video review to other phases of injury care. While most injured patients do not require operative care, those who do are amongst the most injured and thus extension of video review programs into the operating room, or Intraoperative Trauma Video Review (IOTVR), represents a significant opportunity for further quality improvement and insight.</p> Recent findings <p>Early experiences with IOTVR suggest that it is both technically feasible and valuable for capturing key intraoperative processes in trauma care. These include handoff quality, OR (operating room) readiness, and procedural execution. IOTVR provides objective, high-fidelity data that can highlight performance variability and uncover system-level challenges that may not be visible through traditional review methods. While initial studies show promise for using this approach to drive quality improvement and education, data demonstrating a direct impact on clinical outcomes remain limited.</p> Summary <p>This guide outlines how to implement an IOTVR program in trauma centers, covering key steps like stakeholder engagement, policy development, workflow design, and governance. IOTVR captures a critical phase of injury care and offers new opportunities for quality improvement, education, and research.</p>