Data Driven to Distraction

December 17, 2011 3:13 PM

As Doctors Use More Devices, Potential for Distraction Grows — Do too many digital devices distract doctors from their daily rounds and endanger patients?
posted by cenoxo (24 comments total)

This is kind of stupid, I mean...there's potential for health care professionals to get things screwed up no matter what kind of format or on how many devices your records are being stored and viewed. The core issue is process. There's a lot more room for process improvement in health care than the tiny sliver that any sort of technology is going to influence.

This strikes me as agonizing over which color to paint the walls in a school system with no teachers, textbooks, food or safety. If yellow is slightly better than beige, so what?
posted by trackofalljades at 3:19 PM on December 17, 2011 [4 favorites]

The whole article is summed up in the quote "my gut feeling is....."

There's no real data here, just a lot of speculation...
posted by tomswift at 3:29 PM on December 17, 2011 [1 favorite]

Doctors texting while operating is a big problem, especially when your surgeon is sending you pics of your liver along with "Here we are removing the patient's brain. LOL! Oops!"
posted by orme at 3:39 PM on December 17, 2011 [1 favorite]

Perfusion, May 18, 2011— 2010 Survey on cell phone use while performing cardiopulmonary bypass:

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%, with clear generational differences detected when cross-referenced with age groups. 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.

posted by cenoxo at 3:41 PM on December 17, 2011

"examples include a neurosurgeon making personal calls during an operation, a nurse checking airfares during surgery and a poll showing that half of technicians running bypass machines had admitted texting during a procedure."

Why is this article pretending that this is a new phenomena? Anesthesiologists don't need digital devices to read the Wall Street Journal during surgery and doctors routinely return calls from the OR on the hospital land-line.
posted by midmarch snowman at 3:45 PM on December 17, 2011 [7 favorites]

I'm actually in the middle of doing an appendectomy as I type this...
posted by tomswift at 3:49 PM on December 17, 2011 [5 favorites]

Cenoxo, I went and read the rest of that abstract thinking "surely there must be some mitigating factor that makes this not as insane as it sounds" but no, it's as insane as it sounds. To break it down:

• Perfusionists are the people who operate the machine that serves as your heart and lungs during bypass surgery, when your real heart and lungs have been stopped so that the surgeon can operate.
• 55.6% of perfusionists report using a cell phone during bypass surgery, when they should by rights be paying attention to the very important task of ensuring that the patient's brain and body are getting oxygen.
• Approximately 50% of perfusionists consider this to be an unsafe practice, mostly older ones.

What the fuck are these people doing? Why does the perfusionist even have their cell phone in the operating area? Why would people be talking on the phone or sending text messages when they are supposed to be operating someone's fucking heart and lungs? Insanity.

My father works in an ER, I have *got* to ask him about this.
posted by Scientist at 4:12 PM on December 17, 2011

And here I got yelled at in the ER for calling work to tell them I wouldn't be in because I broke my arm.
posted by louche mustachio at 4:30 PM on December 17, 2011

So I've only had the opportunity to see the bypass machine employed once, but the working of the machine once its set up actually requires almost no regular input from the technician. The set up of the machine is pretty complex (so it seemed to me) and activating the bypass is an extremely nerve wracking experience (or so it seemed to me) for the technician making sure everything is traveling the directions it should be and the surgeon who dealing with very important maneuvers with a lot of blood in the operating field. But once the bypass is running and everything has been triple check, the technician is basically watching pumps spin for the next 15-30 minutes.

The technician at the surgery I observed had time to answer a lot of my stupid questions, flirt with the float nurse who was in the room, and fill out some of the paperwork, I dunno if he had a cell phone with him but I wouldn't be surprised if he did and checked it. The perfusionist is not a sterile role in the operating room so it's actually not that weird that whatever they carry on their person outside the OR might still be in their scrub pockets inside the OR.

Yeah the presence of a cell phone introduces a distraction risk. Its conceivable someone could ignore a small error in set up that for whatever reason compromises the system but does not affect blood flow or sound an alarm until something catastrophic happens. BUT I've never been trained on a CPB Machine so I have no idea how easy it is for that to happen. Seems to me there's a fair amount of down time and maybe spending 30 seconds of checking your e-mail would not introduce much risk assuming due diligence was exercised during the critical set up and checks and re-checks.
posted by midmarch snowman at 4:35 PM on December 17, 2011 [1 favorite]

Txt from docMD81: Is my malpractice paid up? I think I just fucked this guys wife.
Txt from docMD81: What? Nooooo!
Txt from docMD81: I meant to say fucked this guys life.
Txt from docMD81: LOL autocorrect.

Txt from docMD81: ...so much blood...
posted by logicpunk at 4:43 PM on December 17, 2011 [12 favorites]

Guess what else they do in OR sometimes.
THEY
LISTEN
TO MUSIC!!!!!









I shit you not...
posted by c13 at 4:54 PM on December 17, 2011

Wow, professionals can at some points not be professional.

Wow, technology has unintended consequences.

THE TIMES IS ON IT! http://twitter.com/nytonit

Seriously, I've only been IMMENSELY AIDED by the growth and omnipresence of technology in hospitals.

It's just too much to know. So many medicines, so much data, so many studies. A medical school dean said in "We can teach you only 15% of what we know." -- THAT WAS IN 1910.

That's why some data would be helpful. Even if some unscrupulous people abuse it, it helps more than it hurts.

Simply the fact that when I'm entering meds for a patient that I can electronically check drug interactions -- which at points (adverse drug reaction) is the diagnosis for why they are in the hospital -- is life-saving jump.

What's amazing is that the article could talk of how there's not enough technology in the right places: I can have the last 70 studies about a question on my screen in less than a minute, BUT why can't my EMR system send reminders to patients about follow up work, send the results electronically to their outpatient providers, and even report back to me about it. Why do I still have to get faxes about patient records from the hospital a couple miles away?

And, even more, there are lots of studies of how the clinical exam is flawed and well, it's sad, but the guy operating at 90% capacity is going to be as good as the guy operating at 99% capacity 98% of the time -- the human-body is sort of forgiving like that. For that 1%, yes, it can be tragic -- but again, so many more are saved.

But, sure, let's quote a couple guys and call it a piece.
posted by skepticallypleased at 4:55 PM on December 17, 2011 [4 favorites]

Irst time I heard Lady Gaga's Bad Romance was during a lap chole.
posted by c13 at 4:55 PM on December 17, 2011

I was amused that one of the 'gut feelings' was voiced in an anaesthesiology magazine. My experience is that some anaesthesiologists are among the most likely of specialists to let their concentration wander, or chat about random stuff, or even doze off, during some extremely long procedures... I usually see some of the less engaged reading a book for long stretches, and more commonly now via an ereader. Which is amusing when you consider that practically alone among docs, they are the only ones getting paid *by the minute* for being there.

My experience of some extremely long OR jobs is that if people are going to be in there doing multiple 6-10 hour ops, back-to-back, they are forced to conduct a not-insignificant portion of their office work and their personal lives within the OR. What's needed is common-sense - there are relatively safe times for certain people in the team to focus on other tasks, and then there's people directly invested at specific times who need to focus on nothing else.
posted by meehawl at 5:27 PM on December 17, 2011

Oh man, I am so busted...
posted by TedW at 6:32 PM on December 17, 2011

All I could think while reading this is how many germs are on cell phones...
posted by Weeping_angel at 6:37 PM on December 17, 2011 [3 favorites]

When I had a C-section five months ago, I had an anesthesiologist and a nurse-anesthetist. The nurse-anesthetist did the actual anesthesia and the anesthesiologist just came in for the surgery to supervise. He was texting for part of the surgery. I was amused, but not particularly bothered, since he was just there to look pretty anyway. And then the anesthesiologist and the nurse-anesthetist and I spent several minutes after the baby headed off to the nursery discussing NCAA basketball prospects for the upcoming season. While the surgeon and the surgery nurses gossiped about people in the hospital.

I mean, all was quiet and concentratey and on-topic when the epidural went in, and when I was being prepped in the OR, and for the three minutes it took from start of surgery until the baby was born and a couple minutes thereafter, but then it was like thirty minutes of stitching, which I gather is pretty repetitive labor. Personally I would have found thirty minutes of lying there staring at the ceiling with my arms strapped down unable to scratch my nose thinking about my insides absolutely interminable if I hadn't been chatting.

If the surgeon had been texting I would have been pissed, though.
posted by Eyebrows McGee at 6:56 PM on December 17, 2011

A guy I play online scrabble with often makes plays in the middle of surgery. He's one of the top heart surgeons in the country. I'd trust him, even if he's considering how to play another bingo while repairing that valve.
posted by incessant at 7:44 PM on December 17, 2011

A dentist was chatting almost nonstop with her assistant while attempting to extract a lower molar. The tool she was using banged into my upper jaw twice and she missed a piece of the problem molar. I was sent home without any painkiller, suffered excruciating pain over the weekend (the clinic with several dentists was closed) and missed work for several days. Distraction doesn't have to involve technology. No matter how much of a hotshot you are, chatting while performing an operation is unprofessional!
posted by juifenasie at 7:59 PM on December 17, 2011

Take their smartphones away and replace them with beepers.
posted by Apocryphon at 8:41 PM on December 17, 2011 [1 favorite]

Appropriate topic for an article that was phoned in.
posted by benzenedream at 9:07 PM on December 17, 2011 [2 favorites]

skepticallypleased: " BUT why can't my EMR system send reminders to patients about follow up work, send the results electronically to their outpatient providers, and even report back to me about it. Why do I still have to get faxes about patient records from the hospital a couple miles away?"

From what I hear from friends in the medical IT industry, it's because efficiency and correctness of data from an end-user's perspective is usually the lowest priority in the deployment of a hospital's IT system. Higher on the list is who gets a promotion, who gets the kickbacks and whose little kingdom is preserved.
posted by vanar sena at 12:27 AM on December 18, 2011

Why is this article pretending that this is a new phenomena? Anesthesiologists don't need digital devices to read the Wall Street Journal during surgery and doctors routinely return calls from the OR on the hospital land-line.

I think people are surprised by it because in medical dramas, any time you see surgery it's all massive arterial bleeds and screaming and "We're losing the patient". Real operations are much more sedate, which is a very good thing.
posted by atrazine at 4:58 AM on December 18, 2011

This is a topic that has been discussed for years in medicine, but no one is quite sure how to approach it. It is worth noting that the article the New York times cites was published in Anesthesiology News, which is not a peer-reviewed journal (although it has broken big stories before). The original article is here, although it may be behind a paywall for most of you (I am at work where we have institutional access to many journals) (It is a slow day so I am not in the OR right now). The article in Perfusion gives a more objective view of distraction and notes its prevalence and the attitudes towards it, but doesn't go so far as to link it to negative outcomes. But these tell only part of the story. Even if there were no smartphones, there are computers already in the OR; the electronic medical record makes this a necessity. In fact, in our ORs there are at least 3 computers in each OR, including one devoted to running the software that generates the anesthesia record. Even if one avoids non-work-related uses of the computer, there are many uses that could be considered appropriate but are still distracting. For example, the computers are often used to check on lab results or look up information about another patient that may be coming to that OR; they are also used to look up formulary information on drugs that may be unfamiliar so that the proper dosage is given and any side effects are known in advance. As we progress ever closer to a completely paper-free medical record (our hospital is well on the way there), these sorts of distraction will only get worse. And its not just the OR. ICUs have a similar plethora of monitors and the information they put out can be overwhelming. False alarms in particular have long been recognized as a problem, but the solution is still out there. To make it worse, many of the monitors use proprietary software and communications protocols, so for the most parts different alarm sounds are random from monitor to monitor, with no standardization between vendors.

I recently read Steve Job's biography, and I read with great interest his critques of the hospital environment. Medical devices urgently need re-designing by someone with his sense of the importance of a simple, inuititive user interface, but I don't see it happening anytime soon.
posted by TedW at 9:48 AM on December 19, 2011