Cellphones in the OR Can Distract from Vital Tasks

If any work places should be distraction-free, a short list would include the command post for launching nuclear arms, the control tower of a busy airport and the operating room. We have no information about the first two, but a recent study shows that the people working in the surgical suite might be monitoring their smartphones instead of monitoring you.

As KaiserHealthNews.org (KHN) and the Washington Post reported, “Cellphone use is not generally restricted in the operating room, but some experts say the time for rules has come. In interviews, many described co-workers’ texting friends and relatives from the surgical suite. Some spoke of colleagues who hide a phone in a drawer and check it when they think no one is watching.”

Sometimes a member of the surgical team might be reviewing pertinent medical data on the device, but too often, they’re being used for decidedly nonmedical purposes. As Dwight Burney, an orthopedic surgeon, told KHN/Post, “Sometimes it’s just stuff like shopping online or checking Facebook. The problem is that it does lead to distraction.”

If you’re a baseball pitcher, being distracted might lead to the runner stealing a base. If you’re a surgeon or anesthesiologist, distraction might mean leaving a sponge inside a patient. It might mean forgetting to check a drug dose. Is texting your buddy about a tee time really worth the risk of causing patient harm?

KHN/Post recalled an incident a few years ago when an anesthesiologist in Texas was accused of sending text messages and e-mails on an iPad while his patient’s oxygen levels were dropping. Supposedly, the anesthesiologist didn’t notice the problem for nearly 20 minutes, and the patient died. The woman’s family sued the doctor, and the case settled.

The American College of Surgeons, the American Academy of Orthopaedic Surgeons and doctors who published a paper a few months ago for the American Society of Anesthesiologists have raised the caution flag about phones in the OR. They want clear rules on whether and how such devices may be used. Some people were concerned about the potential for noise or distraction, and others about the possibility that they could transmit microbes and cause infection. (Who washes her iPhone?)

“No federal regulations or industry-wide quality measures address phone use in health-care settings in general or in the OR,” KHN/Post reported. “And no group tracks whether hospitals have adopted rules for cellphone use.”

Sometimes, these cunning little devices turn into tattletales. In June, we wrote about the Virginia man undergoing a colonoscopy whose phone inadvertently recorded the whole procedure when it was left in his pants pocket on a shelf under the operating table. It recorded shocking comments by the anesthesiologist that prompted the patient to file a successful defamation/malpractice lawsuit.

That event was to the patient’s benefit, but when providers are engaged in personal business, it’s more likely to cause harm. Peter Papadakos, a professor of anesthesiology, surgery, neurology and neurosurgery at the University of Rochester, told KHN/Post, “Once we get into or start using our cellphones, we separate ourselves from the reality of where we are. It’s self-evident: If you’re staring at a phone, you’re not staring at the monitors.”

Such behavior was suggested in the sad demise of comedian Joan Rivers. Her doctor supposedly was taking cellphone pictures during Rivers’ procedure, and although the investigation didn’t directly link Rivers’ death to the doctor’s phone use, it was a serious breach of clinical practice and ethics.

In 2012, the ECRI Institute, a nonprofit enterprise devoted to health-care quality, included cellphone distraction among the top 10 risks that technology could pose to patient safety.

Some hospitals are trying to address the situation. The University of Rochester Medical Center, according to the KHN/Post story, requires staff to keep phones silenced when working with patients, and forbids employees to use phones for personal matters when they’re at any “clinical work stations,” not just operating rooms.

Cardiologist Chandan Devireddy at Emory University oversees a catheterization laboratory where patients undergo cardiac procedures. He forbids staffers from checking e-mail or browsing the Internet when patients are present. At least once a year, his department discusses social media and appropriate cellphone use.

“Appropriate,” in many instances might be the assistance a smartphone offers in bringing up patient information, or consulting with colleagues who aren’t present during a surgery.

But how do supervisors know if their teammates are buying books on Amazon or reviewing lab results “unless you’re videotaping or monitoring all persons at any time of the day?” Devireddy said. So how do you retain the utility of the devices without compromising patient safety?

“Our ability to address patient-care issues is much faster,” Devireddy acknowledged. “The idea of eliminating mobile phones is, I think, a very restrictive one.” He believes that hospitals must find a way to cultivate the benefits while keeping staffers from getting distracted.

Life is full of distractions, and whether it’s a cellphone in the OR or a cute kid in the convertible next to your car, it’s up to the person wielding the tool to make sure it’s used properly. If not, in some cases the consequences are life or death.

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