GOOD QUESTION Do surgeons really need their phones in or near the OR?

Most of us can't imagine spending a day without our precious smartphones, but they pose serious challenges to a surgical facility in the form of disruptions, distractions and even risk of infection. Whether those phones are in the hands of your surgeons and staff or your patients and their accompanying friends and family, you need to be able to answer one important question: Do the benefits of allowing unconditional smartphone use in your facility outweigh the risks? Let's take a closer look.

• Surgeons and staff. At times, having surgeons and staffers on their phones in or near the OR is justified — when another patient is in intensive care or there are serious post-op complications, for example — but those instances should be few and far between. An OR nurse taking a brief moment to text her child or an anesthesiologist passing the downtime by updating his Facebook status might seem like innocent indulgences, but they can distract from the primary task of caring for the patient. Even a momentary distraction could result in the administration of the wrong medication, a mistake in the post-surgical count of sponges or instruments, or the inaccurate or insufficient retelling of discharge instructions.

The situation also presents a troublesome what-if scenario in the event of an adverse outcome. Let's say a patient came in for a colonoscopy and emerged from the procedure with a perforated bowel. If the physician had been using his phone within that time frame, the plaintiff's attorney may try to argue that the perforation resulted from the physician being interrupted by his phone while advancing the scope. As smartphone usage becomes more and more prevalent, attorneys will find themselves armed with ample ammunition, even in cases where an adverse outcome is due to a common complication that occurs in the absence of negligence.

• Patients and patient representatives. Any environment in which a patient may purposely or inadvertently record other patients or their protected health information — the PACU, for example — raises a serious privacy issue. Imagine if someone in your facility recorded an unflattering video of a patient emerging from anesthesia and posted it to social media. While patients are not bound to the Health Insurance Portability and Accountability Act, you may be legally responsible if a patient breaches another patient's privacy.

So if you're going to let patients and their representatives use smartphones, what's the appropriate context for usage? Some patients may tell you they want to record discharge instructions, which is understandable considering the stress of surgery and the fact that they are likely emerging from conscious sedation or general anesthesia. A solution may be to usher the patient and his representative out of PACU and into another room, away from other patients, where they can safely record post-op instructions.

GOOD SIGN Communicate to patients how, where and when they can use their phones.

Consider the well-known case from 2015, in which a Virginia man accidentally recorded the audio of his colonoscopy on his smartphone while he was under sedation. When the patient played back the audio, he heard his anesthesiologist mocking and insulting him. The patient sued for damages and won a $300,000 judgment for defamation and medical malpractice, plus another $200,000 in punitive damages. The anesthesiologist's behavior was inexcusable, but this is just one example of why patients' smartphones should be strictly off limits in the OR.

Minimizing risk
I'm not suggesting you ban smartphones from your facility, but you should define appropriate use — where, when and how — in order to minimize risk. Draw up policies for everyone who enters your facility to determine under what circumstances they can use their phones.

You might consider communicating your policy to patients during your pre-operative phone call to provide NPO instructions and medication reminders. That way you can minimize conflict when the patient arrives at your facility the day of surgery. You may even consider including your written policy as part of your pre-operative paperwork and have each patient acknowledge that they understand it and will comply with it, which you can refer back to later, if needed.

It's inevitable that some people will think the rules don't apply to them. When that happens, you can gently remind them that your policy protects their safety and privacy, as well as the safety and privacy of others. Also let them know that if they don't abide by the policy, it may result in the cancellation of their case.

With surgeons and staff, a written policy lets them know exactly how you expect them to conduct themselves in the workplace in regard to the use of smartphones. If someone deviates from the framework, it then becomes an HR issue: "This is the policy you're required to follow, which we've instituted because it creates unnecessary risk of harm to the patient. If you either don't want to or can't abide by this rule, perhaps this is not the right environment for you."

The jury's still out
The presence of smartphones in or near the OR is a relatively new phenomenon, so we don't yet know all the legal challenges they may create. To my knowledge we haven't yet seen any lawsuits alleging a phone in the OR somehow disrupted medical equipment or sparked a static explosion that resulted in a flash burn, but I can one day see such an argument being presented by a plaintiff's counsel.

Which brings us back to the question I asked at the outset: Do the benefits of allowing the unregulated use of smartphones in your facility outweigh the risks? If you don't take the time to answer now and come up with a workable plan of action, it might be up to a jury to decide for you. OSM