Be smart about smartphone use


Surely you've never surfed Facebook during rounds. But what about glancing at a new email or sending a quick text to your spouse? Smartphones can definitely be an asset in the hospital—putting medical resources at one's fingertips—but are they also a menace, distracting physicians from patient care?

To answer this question, researchers at Jacobi Medical Center in New York surveyed their medicine and pediatrics housestaff and attendings about their own and their colleagues' smartphone use. They found that almost everybody had a smartphone (even back in February 2011), but there was a significant division of opinion about the appropriate way to use one. The findings were published in the October 2012 Journal of Hospital Medicine.

Photo courtesy of Dr Katz-Sidlow
Photo courtesy of Dr. Katz-Sidlow.

Lead author and pediatrician Rachel Katz-Sidlow, MD, recently spoke with ACP Hospitalist about the findings of the smartphone survey and the policy Jacobi Medical Center developed in response, which seems to be helping physicians know when it's OK to check their phones and when to keep that buzzing in their pockets.

Q: Was your research motivated by observations about smartphone use in the hospital?

A: Yes, my coauthors and I are a mixed group of educators and hospitalists. A few years ago we noticed that our learners were commonly bringing their smartphones to the hospital and were using them in all settings throughout their days and nights on the clinical service, and even as they walked through the hallways of the hospital. They can be a very valuable tool in medical education and patient care. In fact, there are now medical schools and residencies that are requiring their trainees to own smartphones.

But about two years ago, as these phones were becoming even more common, some faculty members started complaining to us that they thought that trainees' use of smartphones during academic sessions could be distracting to others and was frankly rude. Besides the rudeness factor, there's also data from the fields of psychology, education and traffic safety showing that multitasking with an electronic device can have negative consequences. But there wasn't much known about the possibility of any unintended negative consequences of smartphone use by physicians in the hospital.

Q: At that time, did your program have any guidelines or rules about smartphone use?

A: No, at that time, people used their smartphones freely. There wasn't any overall regulation of smartphone use in any of our clinical settings. It was really a personal decision of how and when you wanted to use your smartphone. That's the general case in most institutions.

Q: What did your study teach you about smartphone use?

A: As we expected, we found that smartphone ownership rates are very high: 89% of our housestaff and 98% of our attendings owned a smartphone. We found that 57% of housestaff and 28% of faculty regularly used their smartphones during attending rounds. The vast majority of this use was for direct patient care, as we expected. Faculty and housestaff also used the phones for texting and emails during rounds and 15% of residents were Web surfing and accessing Internet sites that had nothing to do with patient care. That was…concerning.

Q: What did the survey find about physicians' opinions on smartphone use?

A: There are differences in how residents and faculty view smartphone use on rounds. In our study, the residents' comments highlighted the positive aspects of smartphone use—the tremendous benefit they have from using smartphones during rounds. Also, they feel like they are actively participating in rounds when they use their smartphones. They also talked about [how] it's a personal choice as to whether or not someone should be able to use a smartphone during rounds. But attendings, on the other hand, tended to highlight the negative aspects of smartphone use on rounds. They talked about the distracting email beeps, the rudeness factor, and the fact that residents may be paying more attention to smartphones than rounds. There were clear differences.

Q: What lessons can hospitalist or residency program leaders take from these findings?

A: Hospitalist leaders should be aware that unregulated smartphone use in the hospital can be yet another source of interruption and distraction in an already very busy environment. Because of the tremendous potential benefits of smartphone use to physicians and their patients, it's very important to find solutions that preserve the benefits of smartphones while preventing unintended negative consequences.

Q: What solution did your program find?

A: We developed a smartphone policy specifically for inpatient attending rounds for use in the departments of medicine and pediatrics. The policy was presented to focus groups of faculty, residents and medical students, revised with their feedback and ultimately put into practice in February of 2012. The policy states that at the start of rounds, all personal mobile communication devices must be silenced. The only allowable use of these devices is for patient care or for urgent personal/family matters. What's most important is that all smartphone use during rounds must be made explicit to the faculty member leading the rounds. No longer is it acceptable for anyone to be secretly using a phone under the table during attending rounds. People are focused on rounds and using the smartphones for allowable uses.

Q: What's been the response to the policy?

A: Since we instituted this policy, we've actually noticed a major culture change in our department, with an awareness that smartphone use in educational and patient sessions needs to be done appropriately and is not a free-for-all. The smartphone policy is included in our clerkship orientation for medical students, and inpatient attendings can reinforce this on an individual basis with their teams. My co-author Dr. Robert Sidlow is ward attending right now and he…makes it a point during his attending rounds to explicitly stop teaching when someone uses a smartphone for any use.

Also, even though our formal policy only covers inpatient attending rounds, we've noticed a dramatic decrease in smartphone use during our noon conferences and grand rounds. Participants are much more focused on the faculty speaker than ever before. There's been a trickle-down effect to other educational conferences.

Q: Has there been any pushback?

A: That's why we incorporated all the stakeholders when we devised this policy, in order to make sure that everybody was happy with it. So we have not had any obvious pushback on it. People seem to be able to use it and find benefit in it, but we are going to be studying it more formally. Our initial study showed that nearly 80% of attendings wanted smartphone policies. It will be interesting to find out how residents view this, but anecdotally there seems to be wide housestaff acceptance and comfort with [having] actual rules.

Q: Do you think the policy should be a model for other hospitals?

A: Each hospital needs to assess its own circumstances and some institutions may be able to institute technology-driven solutions, but in general this seems to be working very well for us, and can serve as a model for other hospitals.

Q: Do you have any other advice to hospitalists on this issue?

A: Hospitalists need to be aware that despite their many benefits, smartphones have a potential to be a distraction if used during times of important clinical information transfer. And they need to be aware of the potential for team members to miss important clinical information if they are distracted by smartphones during attending rounds.

In addition to this being a potential patient safety issue, the concept of a smartphone policy is in line with other policies that are being developed in the area of digital professionalism, such as how physicians use social media. I think there's a recognition now that physicians need to be thinking about how we engage with technology from a professionalism standpoint.