Personal mobile technology is now everywhere in the medical environment. Walk through the hallways of any hospital in this country and you will likely see attendings, residents and medical students in all these settings engaging with their smartphones or tablets.
Smartphones in particular have become an important instrument for today’s medical professional. Doctors can immediately access medication doses, read the latest management of a rare disorder, find tools to educate patients, and talk, text and email locally and globally.
Hospitals are very concerned about protecting patient privacy, and routinely implement policies and procedures to safeguard patient information. But there are other concerns about smartphone use in the hospital that are receiving less attention, including the potential for doctors to become distracted by all this electronic multitasking. Studies from the educational and psychology fields have also shown that there are definite downsides to multitasking with technology while learning.
Concerns about distraction from smartphones in the hospital gained national attention in December 2011 when the Agency for Healthcare Research & Quality (AHRQ) highlighted a clinical case of a patient who was harmed because a resident became distracted while on a smartphone. The resident had been asked by her attending to use her smartphone to access the hospital’s computer system and discontinue the patient’s medication, but an incoming text about an upcoming party distracted her. The original task was not completed and the patient remained on the medication, suffering negative side effects that resulted in a prolonged hospital stay. Fortunately, he survived.
A few days later, The New York Times ran a front page article entitled “As Doctors Use More Devices, Potential for Distraction Grows,” bringing national attention to what the author called “distracted doctoring.” Most of the article presented anecdotal concerns about distraction, as there was little data available on this subject.
Meanwhile at Jacobi Medical Center (an Einstein teaching affiliate and one of 11 acute care hospitals that is part of New York City’s Health and Hospitals Corporation) my colleagues Drs. Allison Ludwig, Scott Miller, Robert Sidlow and I had recently completed a study on this very topic.
We were interested in finding out how many of our inpatient faculty and trainees owned smartphones, what they were doing on their phones, and whether they believed they were distracted by them. To do this, we surveyed all the residents and faculty in the departments of medicine and pediatrics about their experiences using smartphones during inpatient attending rounds. These rounds are an important time of the day, when supervising faculty discuss patients with the residents, and patient care decisions are being made.
We found that 57% of residents and 28% of faculty reported using smartphones regularly during these rounds. As we expected, the clear majority of smartphone use was to access medical references and resources, but team members also used their phones for personal texts and e-mails, and 15% of residents acknowledged using their phones for non-patient care uses (such as web-surfing).
Most concerning was the fact that 19% of residents and 12% of attendings believed they had missed important clinical information because they were distracted by smartphones.
Our survey also found that nearly 80% of our faculty felt that codes of conduct were needed about how to use these phones during rounds.
Based on our findings, Jacobi became one of the first hospitals to institute a “smartphone policy,” detailing how these devices should be used in a clinical setting. The policy states that to minimize distractions, all phones must be silenced at the start of medicine and pediatric inpatient rounds and may only be used for patient care or a personal emergency. Importantly, in all cases, anyone using a phone must make it clear why the phone is being used. Our findings and policy were published in the October 2012 issue of the Journal of Hospital Medicine.
While the study was done at Jacobi, concerns about smartphone use in the hospital are global. Since the article was published, we have been contacted not only by medical professionals and researchers from within the U.S. but from 5 other countries as well, seeking additional information and guidance.
Since adopting the “smartphone policy” almost two years ago, my own department has seen an incredible culture change. When a clinical question comes up on rounds, residents will now ask, ‘Would it be OK to look that up on my phone?’ There is awareness on the part of attendings and trainees that the possibility of distraction is real; our phone use has become explicit, directed to patient care, and harnesses the benefits of smartphones while minimizing distraction.
We now also view the “smartphone policy” not only in terms of patient safety, but as a form of workplace professionalism. Using a phone without explanation during noon conferences or in Grand Rounds has become viewed as unprofessional.
It’s great to see our trainees and ourselves focused on and engaged with the speaker in front of us. I love that when I lead a session with medical students I am interacting with them face to face, rather than looking at the tops of their heads and wondering what they are doing on their mobile devices.