Observations: Using Technology in the O.R.

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October 1, 2013 Volume 77, Number 10
Observations: Using Technology in the O.R. N. Martin Giesecke, M.D.

A faculty member does not have to be a program director to be concerned about the influx of communications technology into the O.R. Elsewhere in this NEWSLETTER, Drs. Jai Mehta and Peter Killoran address “Anesthesia and Mobile Technology: ‘Meaningful Use’ of Small Screens.” They rightly discuss the issues of “Distraction, Disruption and Interruption.”

Let’s look back to 1989, the year I completed my anesthesiology residency. Even then, there were faculty who were uneasy with resident distractions in the O.R. For those faculty, it was inappropriate for a resident to be doing anything in the O.R. other than taking care of a given patient. Thus, the resident was to commit his or her entire focus to that patient. In the view of these faculty, and perhaps rightly so, we, as residents – as learners – should be devoting our entire concentration to the minute- by-minute, even second-by-second, management of a successful anesthetic. To be caught reading a textbook, or even worse, the newspaper or doing a crossword puzzle, was tantamount to shirking one’s responsibility to learn, not to mention the responsibility to the patient. Consider the legal doctrine of >res ipsa loquitur, “the thing speaks for itself.” We knew that the mere act of reading while in the O.R. revealed that we were not giving our total concentration to the patient. Thus, it was a measure of professionalism that we kept our attention riveted to our patients and not a journal or newspaper.

The younger readers should realize that the days I am speaking of were before the widespread use of automated non-invasive blood pressure measurement. So we had to actually pump up the air in the blood pressure cuff and listen to the Karotkoff sounds, while simultaneously watching the pressure gauge to ascertain the blood pressure. And we did this every five minutes in a stable case; more often in an unstable situation. We had to document blood pressures, heart rate, SpO2, ECG rhythm, temperature, etc., on a paper record. There was no automated anesthesia information system gathering all of this material into a legible anesthesia record. This did not leave a great deal of time to become deeply involved in a text or journal article. And what about reference material? If we wanted reference material that we could review perioperatively, we had to read about the case the night before and prepare this material ourselves, taking it into the O.R. as pieces of paper.

Thankfully, times have changed. Information technology has greatly improved. Almost all of us have near- immediate access to a smartphone or tablet computer device. And we can use these devices in innumerable ways to improve patient care. I will be the first to admit that having information so readily at hand can be beneficial. It likely improves patient care to be able to review before an add-on case in the afternoon the anesthetic considerations for patients with pulmonary hypertension, for instance, when that wasn’t one of the cases one read about the prior evening. And as the article by Drs. Mehta and Killoran discusses, there are multiple apps being developed that go above and beyond merely having the smartphone as an informational resource.

The downside is that certain of us have developed a dependency on our smartphones. So now, rather than having it available to use in a pinch to look up a treatment issue, we are using it the way we do in the rest of our normal lives – to maintain constant contact through our electronic devices. Personally, I was slow to transition to a true smartphone, only doing so about a year ago. And I have to admit that while I’m in the O.R., I rarely pay attention to the vibration signaling that I have received a new text message, e-mail or call. But others, those whose behavior has evolved with this ready access to all that is social media, have much more difficulty turning off their attention to these devices.

It is this latter group of physicians that causes us educators so much consternation. We are trying to ensure residents understand that in providing an anesthetic, we are participating in the practice of medicine in the O.R. But most of us, the relatively “senior” faculty, came about in a time when we did not have so many distractions available to us. Sure, we could choose to listen to music while we studied, and we might even be disturbed from those studies by a telephone call. Even so, few of us had to comprehend the level of distraction that exists now, as each of us is bombarded by hundreds of e-mails each day, by a similar number of text messages, by a brain that rather than concentrating on the process of measuring a simple blood pressure every five minutes is being tasked with processing a multitude of other pieces of information.

The vast majority of anesthesiologists make the connection between what is appropriate use of these devices in the O.R. and what is not. Still, there is a small minority of us who may be tempted by the 24/7 access to information and entertainment that smartphones allow. This leads right back to one of the aspects of professionalism I mentioned earlier. That is, if we are reading our smartphone (or texting, or talking to one of our friends), we are not paying full attention to the patient. And paying attention to the patient is our prime concern while in the O.R. Let’s keep our relationship to information technology a positive one in every aspect of our patient care.