Physicians and distracting devices

Introduction

Smartphones, tablets, and other portable electronic devices are commonplace in health care settings. With this comes increased risk for making mistakes, as the lines between personal and professional use of these devices are blurring. ¹

For the remainder of this post, the word “devices” will be used to refer to portable electronic devices, including, but not limited to, smartphones and tablets.

Often used by physicians, residents, and other medical staff to communicate with colleagues and to access medically pertinent information from the internet, these devices are often not limited to work-related issues. Inevitably, there are distractions during the workday that include personal texts, emails, social media notifications, and more. ² When notifications and alerts unpredictably appear on a device’s screen that are un-related to the current task at hand, it is a distraction.

This article offers several techniques to reduce the risk of distraction when using these devices for professional purposes. There are reports of distractions leading to dangerous medical errors, and it is important to be aware of these instances as a means of promoting patient safety. ³

One commonly cited case study focuses on a provider receiving a text message about an upcoming party during hospital rounds. The distraction regarding an RSVP to a party resulted in an incomplete drug order to stop a patient’s anticoagulation medication, causing the patient to almost die during open-heart surgery. ¹

Background information

A study conducted by the Albert Einstein College of Medicine found that approximately 57% of residents and 28% of faculty used smartphones during hospital rounds. Of the population surveyed, 15% of residents admitted to using their smartphones for non-clinical purposes, such as answering texts, personal emails, etc. ⁴

While the majority of use was for clinical purposes, such as referencing medical information and resources, there could be an increased risk of missing important details due to multi-tasking between clinical and non-clinical purposes. Although this study was centered on a hospital setting, there are takeaways that can be applied to any health care setting.

Multi-tasking and device use in health care

According to research by Cleveland Clinic, only 2.5 percent of people are able to multi-task effectively, making true multi-tasking—the act of doing two activities simultaneously—an “illusion.” Instead, what people are really doing when they think they are multi-tasking is a series of “individual actions in rapid succession.” Attention, focus, and learning are sacrificed in favor of speed and quantity, thus increasing the likelihood of error. ⁵  

The Albert Einstein College of Medicine study also found a strong disconnect among respondents who indicated they had colleagues who have been distracted by their devices and individual awareness of their own distraction by devices. This disconnect highlights a significant safety concern.

Techniques to reduce distraction

While multi-tasking is a behavior that is unlikely to change due to the reality and demands of the health care system — and the ubiquity of mobile devices— it is important to consider several techniques to mitigate the risk of medical error. Some of these suggestions may seem obvious, but they can be critical to patient safety. ^{2, 4}

1. Double-check your work. For example, take a brief pause to look over your work in a patient’s progress note before signing off. Doing so can save time in the future and ensure the patient’s information is accurate. ⁴
2. Explain your device use to patients. Patients may feel excluded or dismissed during their visit, if a provider is looking at their screen (on any device) for the majority of the encounter. Simply acknowledging the computer, smartphone use, etc., and explaining why you are using it can help the patient feel valued. ² Intentionally explaining device use to patients may lead to physicians self-monitoring and decreasing non-clinical use given its unprofessionalism.
3. Reduce non-clinical notifications. If you are receiving notifications that are unnecessary to the workday (e.g. social media notifications, etc.), you can mute these notifications by adjusting your device’s notification settings. This will vary on an individual basis, but it is important to consider doing so to reduce the potential for distraction. ² It is also possible to limit certain app activity by setting “screen time” limits for them (e.g. Facebook, Instagram, etc.).
4. Implement “phone-free zones” in your practice or office. These “zones” can be especially helpful in areas where several distracting circumstances co-exist, such as the reception area or other high-traffic areas. Not only is the potential for distraction reduced but taking this action can help to encourage a standard of professionalism throughout the practice. The front office is often the first contact for patients, and a patient’s experience of it can have a strong effect on the patient-physician relationship. ³
5. Establish policies outlining device use- Each health care setting is unique, and therefore, each practice is responsible for establishing policies and procedures that outline its expectations of device use for clinical and non-clinical purposes.³ Policies and procedures allow for standardization among physicians, non-physician providers, and clinical staff. Policies explaining the acceptable use of devices for each type of health care professional and staff member is beneficial from a risk management perspective.

Conclusion

Health care is constantly evolving with the advancement of technology. Communication between colleagues, providers, and patients is much faster now due to this progress; however, like with any advancement, there are new issues that arise.  It is important to reduce distracting device use in health care settings to promote an environment that emphasizes personal accountability and patient safety.

Sources

1. Gold J. Doctors’ Smartphones and iPads May Be Distracting. Kaiser Health News. March 26, 2012. Available at https://khn.org/news/doctors-smart-phones-ipads-distracting/. Accessed May 8, 2019.
2. O’Reilly KB. Don’t let smartphones district from care. American Medical Association. January 20, 2017. Available at https://www.ama-assn.org/delivering-care/patient-support-advocacy/dont-let-smartphones-distract-care. Accessed May 8, 2019.   
3. Gill PS. Kamath A. Gill TS. Distraction: an assessment of smartphone usage in health care work settings. Available at  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437811/. Accessed May 8, 2019.
4. McBride DL. LeVasseur SA. Personal Communication Device Use by Nurses Providing In-Patient Care: Survey of Prevalence, Patters, and Distraction Potential. JMIR Human Factors. April-June 2017. Available at  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408133/. Accessed May 8, 2019.
5. Kubu C. Machado A. The Science is Clear: Why Multitasking doesn’t Work. Health Essentials. June 1, 2017. Cleveland Clinic. Available at https://health.clevelandclinic.org/science-clear-multitasking-doesnt-work/. Accessed May 8, 2019.

Roxanna Maiberger can be reached at roxanna-maiberger@tmlt.org.

About the Author

Roxanna Maiberger is an Associate Risk Management Representative at TMLT. She completed her undergraduate and graduate degrees at The University of Texas at Austin. Her master’s degree is in Public Affairs from the LBJ School of Public Affairs with a concentration in health care policy. Roxanna Maiberger can be reached at roxanna-maiberger@tmlt.org.

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