Congratulations, smartphones! You finally made the Top 10 Health Technology Hazards list this year. The list is an annual compilation of the top hazards caused by technology used in health care, based on the prevalence and severity of incidents reported to the ECRI Institute, a non-profit patient safety organization. The most common hazards on the list include dangers like radiation burns during diagnostic radiology procedures, or surgical fires, or patient monitoring alarms that fail to go off.
But for the first time ever, “caregiver distraction from smartphones and other mobile devices” has made this Top 10 list of patient safety hazards. I’d offer up a high five here, but your hands might be otherwise occupied until you distracted health care providers learn how to put down the damned phone while you’re supposed to be caring for your patients.
In “Distracted Doctoring” – Updating Your Facebook Status in the O.R., I covered some surprising health care examples of such online distractions – like the neurosurgeon making personal calls during an operation, or an O.R. nurse checking airfares in the middle of a procedure.
Distractions from mobile devices are so prevalent throughout the health care system, in fact, that the American Academy of Nurse Anesthetists drafted a position statement in June to address this disturbing and potentially dangerous trend in the operating room.
The statement acknowledges that “continuous clinical observation and vigilance are the basis of safe anesthesia care” and that those working in the O.R. have an ethical responsibility to provide safe patient care by “avoiding all non-essential distractions“, specifically:
“Non-essential distractions, especially those associated with use of mobile devices (e.g., smartphones, tablets, PDAs), may lead to significant patient safety lapses.
“Richardson et al found that many anesthesia professionals felt that such technology was useful for non-urgent matters, but may lead to unwanted interruptions.”
But it’s not just those “unwanted interruptions” when your neurosurgeon is on his 10th personal call during your procedure (yes, this actually happened) that should concern patients. There may indeed be another tech-related hazard in the O.R. while staff are texting, emailing and ordering on eBay (yes, this actually happened). The statement adds:
“When investigating the risks of bacterial contamination, Jeske et al found that even after 40 anesthesiologists used hand sanitizer, over the course of time most personal mobile devices had critical pathogens on them, indicating that these devices can easily transmit pathogens from hand to device and vice versa.
“Bacterial contamination may pose a problem when using mobile phones in patient care areas when current decontamination protocols are not known.”
The statement also cites a particularly disturbing study that hit the news last year. In a report published in the journal Perfusion in which 439 perfusionists working on cardio-pulmonary open heart surgery bypass procedures were surveyed, more than 55% of the respondents reported using their cell phone during the procedure in some form (e.g. phone calls, sending/checking email, internet surfing, social networking, texting).
Additionally, 34.5% acknowledged that they had witnessed a fellow perfusionist distracted with phone use during the procedure.
The statement prudently advises:
“The use of mobile technology and wireless connectivity provides opportunity for distraction by giving users instant internet access and linking users to email, e-magazines, e- books, television shows, social networking outlets, blogs, games, and thousands of non-clinical mobile apps.
“Any inattentive behavior during a procedure, such as reading, texting, gaming or using mobile devices to access non-clinical content, should be considered a potential patient safety issue.”
My question is this: why would it even be remotely necessary for a professional organization to issue a no-brainer directive like this to otherwise intelligent, educated health care professionals?
I guess it’s because it’s just so hard to keep up with Level 19 on Tetris when that stupid patient needs your attention, isn’t it?
During a conference speech in Munich last summer, German Labor Minister Ursula von der Leyen echoed these questions when she called smartphones “the terrorist in your pocket.”
“You are always present. You are always reachable. You are always online. Use your devices, but don’t let them dominate your life, and defend your right to be offline.”
One might also add that patients may now need to defend their own right to safe and focused medical attention during all health care procedures.
And by the way, here is the full list of the ECRI Institute’s top hazards because of use of technology in health care:
- 1. Alarm hazards
- 2. Medication administration errors using infusion pump
- 3. Unnecessary radiation exposures and radiation burns during diagnostic radiology procedures
- 4. Patient/data mismatches in EHRs and other health IT systems
- 5. Interoperability failures with medical devices and health IT systems
- 6. Air embolism hazards
- 7. Inattention to the needs of pediatric patients when using adult technologies
- 8. Inadequate reprocessing of endoscopic devices and surgical instruments
- 9. Caregiver distractions from smartphones and other mobile devices
- 10. Surgical fires
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See also:
- Want a safer O.R? Shut the !@#& up!
- Doctors behaving badly online: how stupidity can cause trouble
- Why you should put that damned phone away
- Dr. Sherry Turkle: “I share, therefore I am”
- News flash: smartphone users obsessively check their devices
- Why narcissists love Facebook
photo: The Patient Safety Initiative
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The Ethical Nag 
A few weeks ago, I called a surgeon for an interview and he answered his cell phone – while he was mid-procedure. I was all kinds of horrified and suggested I call back when he wasn’t, you know, in the middle of SURGERY.
He was surprised but agreed. (Thankfully, when I called again, his nurse answered the phone and said he was busy. Ironically, I think he was busy in the lab, not with a patient.)
He was “surprised”?!?! Are you KIDDING me? Isn’t there somebody you can report this guy to?
Why are phones even allowed in the ER? They should be banned. Always. It’s easy enough to set up a system where the surgeon can be reached in the OR without carrying a personal phone.
I think bringing a phone into the OR is disgusting, not to mention incredibly unhealthy.
Hello Dr. Ruth – why indeed? Kelly’s comment above illustrates the sheer stupidity of surgeons taking personal calls in mid-procedure. Unbelievable!
Unless hospitals (and common sense) take over, prepare for healthcare providers to become even more distracted. We have an entire generation of kids who seem surgically attached to their mobile devices. Do we honestly expect that the same people who can’t take a short car ride or attend grandma’s funeral without being “connected” at all times, will be able to perform surgery that may take hours without their smartphones?
Sadly, I suspect you are 100% correct. Right now we have a number of older users who are not “digital natives” like younger health care workers are. They are our only hope in bringing common sense to the O.R.
Good piece. Dr. Ruth has the policy solution: just ban them in operating rooms and for other critical areas. May be harder to implement policy in other areas.
Problem is, in operating rooms, we are not awake to complain!
“Problem is, in operating rooms, we are not awake to complain!”
Andrew, you are painfully correct! But even if we were awake, how many of us would have the temerity to raise a hand and request the doc/nurse to put away their phones?
I once spoke to a large audience of cardiology staff about women and heart attacks, and reminded them NOT to chat happily about their weekend plans, kids, politics, etc. over the bodies of the patients lying on the gurney beneath them as if we are merely pieces of meat on a slab – worse, INVISIBLE deaf pieces of meat on a slab! It’s about common courtesy.
I wonder how they reacted? Reminds me of one of the early scenes in The Diving Bell and the Butterfly, when the surgeon, as he is closing the eyelid of the ‘locked in’ patient, talks about his ski weekend in St. Moritz!
Interesting you should ask: a number of them (nurses, mind you, not docs) came up to me after the talk and specifically thanked me for the reminder. We live in hope!
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