Personal electronic device use in the operating room: A survey of usage patterns, risks and benefits
Distraction in the operating room poses significant risks to patient safety. Vigilance has been the cornerstone of the well tolerated practice of anaesthesiology since its inception, and improvements in technologies allowing for enhanced vigilance have resulted in a tremendous reduction in anaesthesia-related morbidity and mortality. As technologies have become more complex and numerous, however, the risk of distraction has grown.1,2 Over the past decade, the pervasiveness of personal electronic devices (PEDs) has led to a new form of distraction, as anaesthesia providers use these devices for both professional and personal purposes during patient care. A 2011 article in the New York Times coined the term ‘distracted doctoring’ and focused attention on this growing potential problem.3
Study of texting-while-driving behaviour suggests that PED-use can have an addictive component.4 CAGE questionnaires have been used successfully to gauge levels of addiction in those abusing alcohol or participating in other potentially addictive behaviours.5 We therefore designed a survey to assess anaesthesia provider opinion on PEDs and gauge self-reported level of device use via a previously described modified CAGE questionnaire. Ethical approval for this study (Human Investigation Committee protocol number 2014-348) was provided by the Human Investigation Committee of Beaumont Hospital, Royal Oak, Michigan USA (Chairperson John M. Koerber) on 8 January 2015, after which, a nine-question assessment tool was distributed to anaesthesiologists, residents and CRNAs, through the Association of Anaesthesiology Core Program Directors listserver. Questions included demographic assessment of level of training, availability of wireless internet access in the operating theatre, availability of wired or wireless internet access at the anaesthesia work station, a modified CAGE questionnaire (below) and a final question assessing risk/benefit analysis of PED use in the operating theatre.
Modified CAGE (m-CAGE) Questionnaire
Six hundred and forty-seven respondents completed the assessment tool. Nearly all respondents had wireless internet access in the operating room (611/96%) and wired or wireless access at the anaesthesia work station (604/95%). Fifteen percent reported that their institution had specific PED policies in place, while 51% did not know. One hundred and thirty-three (21%) reported at least two risks on the m-CAGE questionnaire. Of those with positive m-CAGE screens, most had positive responses to two questions (63%), 28% had three positive responses and 9% of all respondents answered ‘yes’ to all four CAGE questions. Nearly all respondents felt that the benefits of PED use somewhat outweigh the risks (average 2.43 ± 1.11 on a 5-point Likert scale).
This survey included the use of a modified CAGE questionnaire. The CAGE questionnaire was initially developed by Ewing over 50 years ago5 for use by primary care physicians as a convenient screening tool for alcohol addiction. The questionnaire has since been validated several times in different populations and has been used to screen for drug use, gambling, tanning and other compulsive behaviours.7 Since 2013, a group at the University of Rochester has used a modified version of the questionnaire to help educate professional groups on addiction to PEDs.6 By using the University of Rochester m-CAGE CAGE (m-CAGE) questionnaire to screen for PED addiction, we hoped to identify an at-risk segment of the anaesthesia provider population and use our findings to make recommendations for appropriate intraoperative PED use.
Our findings suggest that a significant proportion of surveyed providers self-report m-CAGE answers suggestive of addictive behaviour. The near-pervasiveness of wireless signal in the operating theatre, coupled with the pervasiveness of PEDs in general, allows for rapid availability of medical information unlike any other time in history.