Distracted at the bedside

The patient was seriously sick and in the hospital. The doctors had doubled the dose he was taking of a blood-thinning medication to reduce his risk of stroke. But after evaluating his case a couple of days later, they decided to temporarily discontinue the medication and obtain an echocardiogram to make sure the drug was still needed.

A doctor-in-training took the order. As she began entering it in her smartphone, she was distracted by a text message about an upcoming party. She texted a response, the medical team moved on to the next patient… and the order to stop the medication was never completed.

Four days later the patient was rushed into emergency open-heart surgery to stem internal bleeding caused by too high a dose of blood thinner.

This real-life case appears in the online Morbidity and Mortality Rounds of the U.S. Agency for Healthcare Research and Quality and offers an alarming example of an issue that’s becoming increasingly prevalent in health care: the distractions and multitasking associated with information technology.

If the news coverage lately is any indication, there’s reason for growing concern.

The AHRQ case report is but one instance. Although the patient fortunately survived, it was at the cost of a potentially risky emergency surgery and lengthier hospital stay.

A recent article in the New York Times cited several other examples. In one case, a neurosurgeon apparently got distracted while using a wireless headset to make personal calls in the OR, and the patient wound up partially paralyzed. Other examples included a nurse checking airfare prices online during spinal surgery, intensive care unit staffers using hospital computers to visit eBay and Amazon, and technicians texting or talking on their cell phones during surgery.

It had to happen, I suppose. Smartphones, texting, tablets, Twitter and the like are such a common part of everyday life that it’s inevitable they would spill over into the health care setting. What’s concerning are the implications for patient care, where the stakes are so high.

From the New York Times article:

“You walk around the hospital, and what you see is not funny,” said Dr. Peter J. Papadakos, an anesthesiologist and director of critical care at the University of Rochester Medical Center in upstate New York, who added that he had seen nurses, doctors and other staff members glued to their phones, computers and iPads.

“You justify carrying devices around the hospital to do medical records,” he said. “But you can surf the Internet or do Facebook, and sometimes, for whatever reason, Facebook is more tempting.”

“My gut feeling is lives are in danger,” said Dr. Papadakos, who recently published an article on “electronic distraction” in Anesthesiology News, a journal. “We’re not educating people about the problem, and it’s getting worse.”

Patient safety is clearly the most critical issue, but technology may also be exacting a toll on the human connection so essential in health care. Josephine Ensign, a nurse practitioner and blogger in Seattle, last week described an encounter outside a hospital elevator with three employees absorbed in their smartphones.

“Their smartphones collided, and they looked up dazedly, sheepishly apologizing as they stepped on to the elevator,” she wrote. “Then all three resumed communing with their smartphones.”

She writes:

When my father was in the hospital last year, I noticed that his nurses spent much more time on the mobile computer stations outside of his room than they did in direct patient care. He had some terrific nurses, and they told me that they hated how much time they had to spend in checking and entering patient data in the computers. The legitimate use of technology in health care is all in the name of patient safety. But at what cost does it come in terms of the human interaction necessary as the core of all healing?

I’m not sure what the answer should be. Outlawing mobile devices and computers is simply not going to happen; after all, there’s a worthwhile place for technology in health care. And when technology is done well, it can enhance care and increase safety, observes Dr. John Halamka, chief information officer at Beth Israel Deaconess Hospital in Boston and chief information officer and dean for technology at Harvard Medical School.

The real issue seems to lie in the day-to-day details, Halamka writes in a commentary accompanying the AHRQ case study. “Mobile devices are becoming an increasingly important part of the clinical workday. Leveraging the benefits while applying technology and policy risk mitigations will result in their optimal use.”

Read more about it here and here.

Photo: Wikimedia Commons

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