Educate your hospital staff to protect against text-related mistakes

I was shocked when I read a harrowing story by John Halamka, MD, CIO of Beth Israel Deaconess Medical Center, about a resident who forgot to input a crucial prescription change because she was distracted by a personal text on her smartphone. The ultimate outcome: a patient crashed and needed emergency cardiac surgery.

In truth, it's a mishap that could have occurred at any number of hospitals around the U.S. Why? One big reason is that the resident used her smartphone both for personal and professional tasks, including entering orders into the hospital's CPOE system. During a rounding session, the attending physician told the resident to stop the patient's warfarin prescription until an ECG could be performed to confirm the cardiac problem that required the blood-thinning medication.

And that's when it went wrong, Halamka says. "The resident began to enter the order into her smartphone. As she was entering the order, the resident received a text message from a friend regarding an upcoming party, and she confirmed her attendance through text messaging." However, she never completed the order discontinuing the warfarin, and the patient ended up receiving an elevated dose for another three days. As a result, blood collected around the heart, and the patient needed emergency open-heart surgery, Halamka explains.

A recent story in the New York Times broadens the issue beyond rookie physicians. It reveals blood transfusion techs texting during procedures, surgeons chatting on cell phone headsets during operations (and in one case making a major medical mistake), nurses texting while intubating patients, and more. A commentary published in last month's Anesthesiology News (reg. required) revealed problems among anesthesiologists, as well.

The message is clear: Hospitals need to re-emphasize professional standards of conduct and how they apply to communicating on mobile devices during work.

To be fair, texting is just another example of a distraction that interferes with clinician concentration, a number of experts tell FierceMobileHealthcare. In years past it might have been pagers or phone calls. A study published a few years ago at Hennepin County Medical Center found that physicians were interrupted up to 100 times an hour, "and that was long before texting and apps," medical center CMIO Kevin Larsen says.

Still, the benefits of smartphones in healthcare clearly outweigh the risks of distraction. Texting is an emerging communications tool, and users clearly haven't quite found the appropriate balance yet between personal and professional functions on their mobile devices.

Several professionals believe that the first and best place to start is educating staff about appropriate and inappropriate messaging behavior. It may sound like a soft solution, but talking through the issue during staff meetings or other group get-togethers often can be more effective than creating an iron-clad policy, Todd Richardson, CIO of Evansville, Ind.-based Deaconess Health System, tells FierceMobileHealthcare.

For example, it's clearly not appropriate for a surgeon to text a birthday message to her husband while she's in the middle of open-heart surgery. But is it OK for that same surgeon to take 20 seconds after the procedure--but before going out to inform the family of the operation's outcome--to send the same text? These kinds of questions should elicit some lively discussion and possibly a new view of professional conduct that includes mobile technology.

Deaconess does have a cell phone use policy that boils down to the honor system, according to CMIO Greg Hindahl. "Use it for work related things while you're clocked in and personal things while you're not working," Hindahl tells FierceMobileHealthcare. It's "very difficult to police, but it is critical for our managers to monitor the use and hold [the staff they manage] accountable for smartphone use and that they are only using it for work related activities during work."

Outlawing mobile phones altogether during work at this point, however, "would be akin to book burning in my opinion," he adds.

Still, some hospitals are choosing to do just that in some situations. Dio Sumagaysay, administrative director of 24 operating rooms at Oregon Health & Science University hospitals, banned any non-patient-care-related activity (including electronic communications) in ORs. According to the New York Times article, they were officially designated "quiet zones."

In truth, it's a policy that might make sense outside the OR too, in some patient exam rooms, during delicate healthcare procedures, and the like. Beth Israel is pilot-testing new policies for access to personal email or social networks, to see if either might help to reduce distractions, Halamka says.

Others, though, say that technology can take care of the problem, with sandboxing, partitioning and alert mechanisms that segregate personal from professional alerts. Beth Israel is testing out several technologies to separate personal and professional tasks on the more than 2,000-plus smartphones, tablets and other mobile devices in use at the facility, Halamka says.

What do you think? Is this an education problem, or a technology problem? Give us your thoughts, we'd love to hear what you have to say. - Sara