Wednesday, August 27, 2014

Time To Ban Cell Phones In The Operating Room

For decades anesthesiologists were at the forefront in promoting patient safety. From encouraging the use of inventions like the end tidal CO2 monitor to developing the ASA Closed Claims Project to identify potential sources of patient injury, anesthesiologists have rightly been proud of their role in enhancing patient confidence when they enter the hospital.

But now all those years of hard work may be for naught. Thanks to the ubiquity of internet connected devices like smartphones and tablets, anesthesiologists are suddenly being tagged with a reputation for being distracted and inattentive. We have already seen an anesthesiologist in Texas accused of allowing his patient to die under his care because he was too busy posting on Facebook to notice his patient was hypoxic.

In our own institution we are starting to hear more and more surgeons complain about anesthesiologists who are too busy on their electronics to notice that the patient on the operating table is moving, hypotensive, or, in a MAC case, aspirating. Our once sterling reputation for being the patient's advocate while in the OR is slowly becoming a farce.

Anesthesiologists aren't the first professionals to become seduced by the fatal attraction of digital devices. In 2008, a train engineer in Los Angeles was found to be texting right up until he had a head on collision with another train killing 25 people and injuring 135. He himself was killed in the accident. Then there were the two Delta Airlines pilots who were so distracted on their computers that they totally missed their destination and overshot Minneapolis by over 100 miles. Studies have shown that using cellphones while driving is just as dangerous as driving while intoxicated. That's why 44 states ban texting while driving and 12 states ban the handheld use of cellphones.

According to Delta Airlines policy on using electronic devices while flying, "Using laptops or engaging in activity unrelated to the pilots' command of the aircraft during flight is strictly against the airline's flight deck policies and violations of that policy will result in termination." Sounds like words that should be used in formulating OR policies also.

Imagine if you asked your anesthesia colleague to provide the anesthesia for your mother's hip replacement. How would you feel if during the procedure you quickly peeked into the operating room window and saw your friend surfing the net on his tablet? So how do you think families would feel if they knew that their anesthesiologist was reading articles on when he should be watching the patient.

Remember the paranoia we all felt as anesthesia residents? During those early years of training we were terrified that our patient would crump while under our care. Ten times worse if the patient collapses just as the attending walks in. Somewhere along the line we have lost our fear of bad outcomes and decided that anesthesia is so safe that it no longer needs our constant attention. That of course is the fool's errand that will lead us to catastrophe and ruin.

Granted distracted anesthesia rarely causes a fatal event. But it often increases the anesthesiologist's response time to changing patient conditions. If the patient's oxygen saturation starts drifting lower, how likely is the anesthesiologist going to jump on the situation if he is trying to quickly finish up his text? If the blood pressure suddenly shoots up, will the anesthesiologist rapidly administer a treatment if he is engrossed in a game of Flappy Bird? During an operation, seconds count. That's why we love all the real time monitors that are now available to us, unlike the old days of feeling for a patient's pulse every 3-5 minutes. But what good is all this monitoring if we don't respond to the information that is given to us?

Therefore I think a ban on smartphone and tablet use should be considered for operating rooms. There are too many instances of these machines causing harm in the workplace and zero cases of it helping. "But what if my son was in an emergency and needed to call me right away?" Well, how would you handle that situation a decade ago? Back then smart devices were not so plentiful and yet we all survived the era before iPhones became popular. There is still the operating room and hospital phones that can reach you for emergencies. Pagers are still commonly found.

Now I am no angel myself when it comes to using electronic devices while working. While I try to minimize the amount of time I'm on the internet, invariably a case will become prolonged and the temptation to sneak a peek at my phone becomes too great to overcome. That quick look soon becomes a lengthy review of emails, text messages, news sites and other activities that pulls me away from my patient and the case at hand. Before I know it the surgeon is screaming, "Anesthesia, the patient is waking up!" and I realize I hadn't redosed the paralytic in some time.

Perhaps a total ban on cellphones is too draconian. How about trying just one or two days a week without the phone to get yourself reacquainted with actually monitoring your patients. It doesn't even have to be the whole day. Looking at the phone between cases is acceptable. But from the time a patient rolls into the operating room to the time you drop him off in recovery, the phone should stay in your pocket or bag. It will not be the end of the world.

If we anesthesiologists don't get our acts together on this, somebody else will. Either the ASA will be forced to issue a standard of care guideline regarding electronics devices in the operating room or the government will pass down laws similar to the driving while texting laws. Then something as simple as answering a text in the operating room could become a criminal offense. We would only have our own impropriety to blame.


  1. I find it very difficult to stay awake in long cases w/o having something stimulating to do (like texting). I have seen anesthesiologists fall asleep during the middle of cases.. so I'd rather have an awake anesthesiologists than a sleeping one. Besides, if phones and tablets are banned, they'll find something else to do. No way they just sit thru a 8 hr procedure staring at the patient.

  2. Have we made anesthesia monitoring so advanced that human intervention is barely needed to keep a patient alive? Is it any wonder that lesser trained personnel or even robots are encroaching on the functions that formerly were the domain of rigorously trained anesthesiologists?