'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 on p. 33.)

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."

Hospitalwide 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, as the captain of the ship in the operating room, 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."


• Gail Gazelle, MD, Assistant Professor of Medicine, Harvard Medical School, Boston. Telephone: (617) 732-5138. E-mail: drgazelle@mdcanhelp.com.

• Keley John Booth, MD, Chairman of Anesthesiology, Integris Health, Oklahoma City, OK. Telephone: (405) 636-7147. E-mail: Keley.Booth@surgerylogistics.com.