Distractions in the Operating Room: Should the Use of Personal Computers Be Banned during the Administration of Anesthesia?

Steven Dean, CRNA, MS

Letter to the Editor:

To the Editor:

Due to the availability of wireless technology, the personal laptop computer is making its way into operating rooms. While useful in many instances, it can be a distraction as well as taking up space and obscuring the view of the monitoring array. Slagle and Weinger1 note that with the introduction of electronic patient care information, the opportunities and allure of electronic non-patient care activities, e.g., web surfing, are increasing.

A few reports of cell phone texting during driving and operating heavy machinery and trains have made headlines. One car magazine conducted a test to determine how long it takes to hit the brake when sober, when legally drunk at 0.08 alcohol level, when reading e-mail, and when sending a text. When driving 70 miles per hour on a deserted air strip a driver reacted slower when texting and e-mailing than when legally drunk.2 The results:

Unimpaired: 0.54 seconds to brake
Legally drunk: add 4 feet
Reading e-mail: add 36 feet
Sending a text: add 70 feet

It is intriguing to consider whether parallels can be drawn between texting and driving and computer use during the administrations of anesthesia.

The introduction of new technology and the impact it has on a multitude of actions is not declared until someone or something is involved in an incident that causes attention. A recent example occurred when 2 pilots apparently became so engrossed in the use of laptop computers that they overshot their destination. They were so focused on their laptops that they were out of communication with air traffic controllers and their airline for more than an hour. They didn’t realize their mistake until contacted by a flight attendant about 5 minutes before the flight’s scheduled landing.3 A Federal Aviation Administration (FAA) Administrator commented that, "The pilots forgot that their first job was to focus on flying the plane." He continued, "I can’t regulate professionalism. With everything we know about human factors, there are still those who just ignore the common sense rules of safety." He also noted that the pilots lost total situational awareness.4

Routine intraoperative anesthesia care has already been compared to aviation and both have been described as consisting of hours of boredom punctuated by moments of terror.1 These examples invoke the need to question the activities of anesthesia providers. Should they surf the internet and answer e-mail during surgery? Can they be trusted to monitor themselves so that they do not become detached? This author is aware of at least one institution that has addressed the issue of intraoperative personal computer use by establishing a policy prohibiting it. This was enacted after an anesthesia provider failed to observe that the surgery had ended because his attention was diverted by the use of his computer.

Policies and procedures are developed to establish uniform protocols for every patient. Policies help to dictate actions and reinforce the decision making process as well as ensure performance is consistent and meets the institution’s and patient’s needs.

Hospitals have a huge role to play in the provision of a safe health care environment. Since clinical training and experience do not necessarily address use of intriguing new technologies, having a policy of no personal internet use would enhance patient safety. All members of the OR team would be focused on the patient, increasing the safety of the patient as well as promoting a sense of teamwork.

Steven Dean, CRNA, MS
McKinney, TX


References

  1. Slagle JM, Weinger MB. Effects of intraoperative reading on vigilance and workload during anesthesia care in an academic medical center. Anesthesiology 2009;110:275-83.
  2. LeBeau, P. Texting and driving worse than drinking and driving. CNBC Online. June 25, 2009. Available at: http://www.cnbc.com/id/31545004/site/14081545. Accessed November 23, 2009.
  3. Lowy J. Working on their laptops, wayward pilots say. Associated Press/Yahoo News. October 26, 2009. Available at: http://news.yahoo.com/s/ap/20091026/ap_on_bi_ge/us_northwest_flight_overflown. Accessed November 23, 2009.
  4. Lowy J. FAA chief: Pilots must refocus on professionalism. Associated Press. November 4, 2009. Available at: http://www.google.com/hostednews/ap/article/ALeqM5ifNY0IbJ_tg0KMW-1u5fIn2Jc_HQD9BOVOS00. Accessed November 23, 2009.