Everyone has a smartphone nowadays. They are wonderful devices, allowing us to constantly connect with our family and friends, surf the web from anywhere, use apps, record videos, and take photographs. Smartphones are common in the hospital too, and these devices have the potential to improve patient care. For example, they can facilitate medical calculations, serve as timers, and allow medical information to be looked up at the point of care.

However smartphones are often misused by health professionals and can threaten patient safety, degrade professional behavior, and violate patient confidentiality.

Threats to Patient Safety

• These devices induce frequent distractions during patient care. For example, a health professional can be interrupted during sign-out, rounds, or even during the resuscitation of a patient by the smartphone ringing with a phone call or pinging with a new text message. Experts have described an addiction-like behavior to these devices, where users respond instantly to stimuli from the device, check the device frequently, and use every free moment to interact with the device. Each such interaction induces a dopamine spike in the brain, which further reinforces addiction-like behavior.
• These devices promote inattention or ‘continuous partial attention,’ allowing a person to physically be in one place and mentally in another place. Thus a health professional using a smartphone during patient care may not pick up signs that a patient is deteriorating and may not respond to alarms and signals from monitors, or other health professionals.
• Research has shown that these devices become colonized with bacteria, including multi-drug resistant organisms such as MRSA. They can then serve as reservoirs that transmit these bacteria to other patients, or to the health professionals themselves (and their families when they take these devices home). Unlike computer keyboards which can also get contaminated but can be wiped down with bactericidal wipes, smartphones are never cleaned, and therefore may carry years of debris and bacteria on them.

Detriments to Professionalism

• Health professionals may text or surfing the web as they care for patients (described as ‘texting while doctoring’ in one article). Even if they are using the device for genuine medical reasons such as looking up a drug dose, colleagues or patients observing the professional are not aware of what the device is being used for, and may therefore mistakenly perceive unprofessional behavior.
• Because of the inattention encouraged by these devices, the professionals may be less engaged in their interactions with colleagues and patients. They may only pay partial attention and may try to multitask as they talk to colleagues and patients. This might result in them being less empathic and less ‘present’ during interactions.

Violations of Patient Confidentiality

Finally, smartphones can lead to violations of patient confidentiality because the cameras on these devices allow health professionals to easily shoot photographs and video in the workplace. The face, private body parts and other sensitive images of the patient or family members can be captured without approval. In some cases neither the user of the smartphone nor the subject may realize that such sensitive images are being captured. If such violations of patient confidentiality are discovered, the health professional may be subjected to severe repercussions, including job termination.

How Can We Mitigate These Threats?

How can we prevent these concerns arising from the use of smartphones in the hospital? There are four possible solutions:

1. Appeal to health professionals and educate them about the appropriate use of smartphones during patient care. For example, in one institution, team members were instructed to inform the person leading rounds before using a smartphone for a legitimate medical reason during rounds. However, with the near-addictive nature of these devices and the Pavlovian response that many health professionals have to these devices, it is unlikely that appeals or educational strategies to health professionals will be effective in themselves.
2. Provide all health professionals with hospital-issue smartphones that have inbuilt restrictions to only allow legitimate medical use. This approach is likely to be more effective than pure educational strategies, but is expensive, and may not eliminate inattention and other safety threats.
3. Ban health professionals from using smartphones in patient care areas, but allow them to carry the phones. The advantage of this strategy is that the smartphone is not likely to get lost (as it may if left outside the unit) and that professionals who are expecting an urgent message (phone or text) will have immediate access to the message. However, this strategy is also not likely to be very effective, since it too relies on human behavior, and on the ability of the professionals to restrain their impulses. It is hard to ensure that the phone is not used, and supervisors and colleagues might be put in the position of having to remind or enforce the policy with non-compliers. If the device is turned off while it is on the person, the strategy might be more effective. This strategy does not eliminate the risk of the smartphones becoming colonized with dangerous hospital bacteria.
4. Ban the presence of smartphones in patient care areas and ask health professionals to leave the devices in their lockers or in secure places in their call rooms or offices. In order for this to be effective, and to pre-empt complaints about lack of access to legitimate medical uses of these devices, a single laptop computer can be made available during rounds or at the bedside for medical information to be looked up (in rounds, a single person can be assigned to be the ‘looker-upper’ of information). This strategy is likely to be most effective and have the highest compliance because the rule is simple (‘no smartphones in patient care areas’). It is also likely to prevent colonization of smartphones with hospital bacteria and transfer of these bacteria to the homes and family members of health professionals. However, this policy is likely to be unpopular, can still be violated, and require reminders or enforcement with non-compliers.

Gautham Suresh, MD, is a neonatologist at the Baylor College of Medicine. His professional interests include patient safety, healthcare quality improvement, and evidence-based decision making.