'Distracted doctoring' recognized as hazard
'Distracted doctoring' recognized as hazard
All manner of electronic devices are common in any healthcare setting, and individuals increasingly are likely to use their own smart phones, tablets, and other personal electronics while at work. The proliferation of electronics is leading some patient safety experts to worry that patient safety might be threatened by "distracted doctoring."
The problem is moving higher on the long list of patient safety concerns, says Gail Gazelle, MD, an assistant professor of medicine at Harvard Medical School in Boston and one of the first physicians in the country to start a direct patient advocacy practice, www.MDCanHelp.com.
"It is a rare person who does not admit to arriving at a destination while on their cell and not recalling how they drove there. Just as we understand that drivers are distracted by cell calls, cell calls to physicians and nurses provide a concerning distraction," Gazelle says. "There is no question that this can compromise patient care."
Research indicates that clinicians sometimes are astonishingly comfortable about mixing patient care with using their own personal devices. An article in the journal Perfusion documented that 55% of technicians who monitor bypass machines admit to talking on their cell phones during heart surgery. Fifty percent also said they had texted during surgery. (For more on that research, see the story at below)
About 40% of the technicians said that talking on the cell phone during surgery was "always an unsafe practice," and 50% said the same about texting.
The spectrum of effects is broad, Gazelle says. At one end, focus on a text or call leaves patients feeling as if there is less focus on them, which leaves them even more vulnerable and disempowered, thus less likely to speak up about concerns or problems.
"Knowing what we do about the importance of patient participation in avoiding medical errors, this may not be a small concern," she says. "At the extreme end of the spectrum, the distracted clinician is at risk for overt errors in concentration, judgment, and technique."
Facility policies on the use of personal electronics are necessary but will not solve the problem, Gazelle says. A culture change is more important. Solving the problem will require getting the ear of physician leadership, Gazelle says. Physician leaders must agree that distracted doctoring is a problem, then lead by example, she says. Surgeons in particular should make clear they will not be distracted by their own devices and will not accept others on the team using personal electronics during surgery, she suggests.
Keley John Booth, MD, chairman of anesthesiology at Integris Health in Oklahoma City, OK, also is concerned about distracted doctoring and agrees that a culture change within the institution is the foundation of any solution. "Just as The Joint Commission posted an alert on the disruptive clinician in 2008, I believe we are due for an alert on the use of cellular devices," Booth says. "I also believe that patients and clinicians need to be empowered to tell users that their behavior is putting patients at risk."
Because each subsequent generation is more used to using their devices all the time, Booth predicts that the use of personal devices will only increase unless the institution delivers the message that the healthcare workplace must be an exception to their typical usage.
"We can't stop people from using this technology, but we can make it clear that some times are not appropriate. We have to create an atmosphere in which people are comfortable asking a coworker why they are using their cell phone during patient care," Booth says. "It can be done in a way that isn't confrontational, but by asking you can remind them to think more about when they're pulling out their smart phone and maybe wait until a more appropriate time."
Heart surgery techs use cell phones in surgery Research from SUNY Upstate Medical University in Syracuse, NY, documents that heart bypass technicians admit to using their cell phones during surgery, but they also contend that the practice is unsafe.1 There were 439 respondents, with age ranges of 20-30 years (14.2%), 31-40 years (26.5%), 41-50 years (26.7%), 51-60 years (26.7%), and more than 60 years (5.9%). The use of a cell phone during the performance of cardiopulmonary bypass (CPB) was reported by 55.6% of perfusionists. Sending text messages while performing CPB was acknowledged by 49.2%. For smart phone features, perfusionists report having accessed e-mail (21%), used the internet (15.1%), or have checked/posted on social networking sites (3.1%) while performing CPB. Safety concerns were expressed by 78.3% who believe that cell phones can introduce a potentially significant safety risk to patients. Speaking on a cell phone and text messaging during CPB were regarded as "always an unsafe practice" by 42.3% and 51.7% of respondents, respectively. Personal distraction by cell phone use that negatively affected performance was admitted by 7.3%, whereas witnessing another perfusionist distracted with phone/text while on CPB was acknowledged by 33.7% of respondents. The researchers noted that there are clear generational differences in opinions on the role and/or appropriateness of cell phones during bypass. "This survey suggests that the majority of perfusionists believe cell phones raise significant safety issues while operating the heart-lung machine. However, the majority also have used a cell phone while performing this activity," the authors wrote. "Such distractions have the potential to be disastrous." Reference
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