Pagers vs Smartphones – Part 2

October 10, 2013 The Trauma Pro Leave a comment

Yesterday, I wrote about using smartphones in place of good, old-fashioned dumb pagers. Reader wang-kevin reblogged it and referenced another new article citing the pitfalls of the phones.

The article was a recital of 10 problems with smartphones in clinical care. These were derived from articles citing known shortcomings of these devices. Here’s a brief listing of them. In my opinion, only the bolded ones are significant for normal clinical use.

Disrupted clinical communication

Audio distortion – The audio quality of cell phones has never been a priority for the carriers. There may be an opportunity for misunderstanding spoken orders (e.g. the number “sixteen”) due to the usual poor audio quality.
Faulty monologue – Texts may be sent that contain significant misspellings or errors. Fortunately, entering orders via text message is not valid.
Fumbled messages – This refers to email that is not properly titled, or with ambiguous language or missing attachments.
Missive avalanches – (who thinks these up?) Caused by inadvertent “reply all” or large chains of messages.

Social disengagement

Mindless checking – Alas, this malady affects nearly everyone with a smartphone. And it’s probably not medical stuff being checked (think Facebook).
Surrounding neglect – This occurs when mindless checking meets walking. Less likely in a hospital.

Failures of technology

Unanticipated loss – Again, most trauma professionals are very mindful of their phones, so not very likely.
Myth of dependability – This one is very important. Sometimes texts are delayed, or calls go straight to voicemail without ringing the phone. Pagers are a bit less finicky.

Direct patient harm

Nosocomial infections – Yes, really. There have been a host of articles showing that white coats, stethoscopes, ties, magazines, even sanitizing foam dispensers are colonized with bad bacteria. Your phone can be as well, and it’s a bit harder to sterilize.
Breached confidentiality – Lose an unlocked phone, and there could be confidential information on it. But it’s not very likely, since there are no good electronic medical record systems for phones yet.

Bottom line: There’s really no new information in this article that people don’t already know. And only a minority of the “issues” are pertinent to real clinical care. The rest may be significant if the phone is used for general daily use at work. Given the sheer number of brands and models of smartphones out there, they are here to stay. This has given rise to the bring your own device (BYOD) concept, meaning that it won’t be possible for a hospital to mandate that only one specific smartphone is acceptable. Not unless they want to buy that model for every clinical employee.

Related posts:

Reference: Pitfalls with smartphones in medicine. J General Internal Medicine 28(10):1260-1263, 2013.

General

Pagers vs Smartphones. Duh!

October 9, 2013 The Trauma Pro Leave a comment

I wrote about good, old-fashioned pagers yesterday. They are very old, yet reliable technology. But these days, smartphones are all the rage. People walk around everywhere, staring at them. Are they useful in a hospital setting?

These days, 90% or so of healthcare providers carry a smartphone. They can transmit and receive much more information than a pager ever could. Would trauma team members at a Level I US trauma center find them valuable? The University of Arizona, Tucson sent a questionnaire to surgeons, residents, and midlevel providers rotating through their trauma service asking them a series of 31 questions about use of these devices.

Here are the factoids:

50 people completed the survey, most of whom (40) were residents. It appears that everyone was forced to return it.
94% were in favor of using it for communications
78% found it easy to use and user friendly
98% believed that it improved speed and quality of communication
98% believed it improved the accessibility of team members
90% felt that it improved physician response time
4% believed that it could not be used due to HIPAA regulations

Bottom line: This is a good example of an unscientific study dressed up to look a little scientific. And it essentially confirms the bias of the researchers. Nonetheless, it is an indicator of where we’re heading with in-hospital and out-of-hospital communications. The days of good, old-fashioned pagers and walkie-talkies are rapidly waning. Smartphones, and whatever follows (Google Glass?), are rapidly replacing them. The only obstacles now are ensuring good signal strength deep inside hospital buildings, and being ever mindful of HIPAA requirements.

Related posts:

Reference: Improving communication in Level I trauma centers: replacing pagers with smartphones. Telemedicine and e-Health, 19(3):150-153, 2013.

General

Paging And The Trauma Pro

October 8, 2013 The Trauma Pro Leave a comment

People who work in hospitals, particularly physicians, physician assistants, nurse practitioners and residents are throwbacks who still use old-fashioned paging technology. My colleague, the Skeptical Scalpel, recently lamented this fact in one of his blog posts. But they do seem to be a necessary evil, since cellular coverage is often limited deep inside of buildings.

But how much to trauma professionals get paged? An oral presentation at the recent Congress of Neurological Surgeons described a study that monitored paging practices between nurses and neurosurgical residents.

Medical students were paid to follow neurosurgical residents during 8 12-hour call shifts. They recorded the paging number and location, priority, and what the resident was doing when paged. The results were enlightening but not surprising:

55 pages were received per shift, on average, ranging from 33 to 75
An average of 5 pages per hour were received, with a range of 2 to 7
A substantial number of pages were received during sleep times (4 per hour)
It took an average of 1.4 minutes to return the page
68% of pages were non-urgent
65% interrupted a patient care activity
An average of 1.1 hours was spent returning pages per shift

Bottom line: Yes, we are throwbacks using an old technology. But it does serve us well. Unfortunately, it’s an old technology being used in an inefficient manner. I recommend that nursing units make it a practice to maintain a “page list” of nonurgent items. The trauma professional can then stop by or call each unit periodically (every 2 hours or some other appropriate time interval) and deal with all of them at once. Obviously, urgent and emergent problems should still be called immediately. This will ensure that routine issues are taken care of in a timely manner and the trauma pro can attend to their other duties as efficiently as possible.

Related posts:

Reference: Oral Paper 113: An Observational Study of Hospital Paging Practices and Workflow Interruption Among On-call Junior Neurosurgery Residents. Presented at the Congress of Neurological Surgeons 2012.

General