Distracting Devices in Healthcare: Malpractice Implications

Digital distraction in healthcare is a threat to patient safety and physician well-being. This phenomenon involves the habitual use of personal electronic devices by healthcare providers for nonclinical purposes during appointments and procedures. Some call it “distracted doctoring.” Matt Richtel, a New York Times journalist who won a Pulitzer Prize for his work on distracted driving, coined the term “distracted doctoring” in 2011.¹ Like driving, attending to a patient’s complex care needs is a high-risk activity that requires undivided attention and presence in the moment to ensure the safety and protection of others.

This threat is now widely referred to as “distracted practice,” and it affects all healthcare workers and staff. While distraction is particularly concerning in the operating room, emergency room, and critical care areas, it can impact all healthcare settings—including the office practice. Personal electronic devices can create a digital distraction so engrossing that it consumes awareness, potentially preventing healthcare providers from focusing on the primary task at hand—caring for and interacting with patients. The consequences can be devastating.

Our Devices Are Addictive

In today’s electronic culture, it has become difficult to function without personal electronic devices. Growing evidence, however, shows that our personal electronic devices and social media are addictive.² This is because our dopamine systems are stimulated by unpredictable, small, incomplete bursts of information with visual or auditory cues. For example, we never know when we will receive a text message. We may keep checking to see who liked our recent Facebook post. And when our devices make sounds or vibrate, we know our reward is coming. As with gambling or playing the lottery, however, the anticipation of the reward is usually better than the reward itself. This results in what some call “seeking” and “wanting” behaviors. Instant gratification encourages dopamine looping, and it then becomes more difficult to stop the cycle.

Distraction can also be both a symptom of and a contributor to healthcare provider stress and burnout. As a symptom of burnout, digital distraction is a way to escape a stressful environment. As a contributor to burnout, digital distraction impedes human interaction because of the sheer volume of data demanding our attention. (For more information, see our Burnout resources.)

Medical Malpractice Implications

For most healthcare providers, distractions and interruptions are considered part of the job; it is the nature of our work. If we consider healthcare distraction on a continuum, on one end are distractions related to clinical care (e.g., answering team member questions or responding to surgical equipment alarms). On the other end of the continuum are distractions unrelated to clinical care (e.g., making personal phone calls, sending personal text messages, checking social media sites, playing games, or searching airline flights).

From a litigation perspective, the distinction between distractions related to clinical care and those unrelated to clinical care is important. When an allegation is made that an adverse event was caused by distracted practice, a distraction caused by an activity related to clinical care may be found to be within the standard of care and is, therefore, often defensible. But where it can be shown that the distraction was caused by non-patient matters, the plaintiff’s attorney will certainly use that information against the defendant. In these situations, the metadata (e.g., cell phone records and findings from hard drives) obtained during electronic discovery serves as the “expert witness.” Even if the defendant’s clinical care was within the standard, the fact that cell phone records indicate that the healthcare provider was surfing the internet or checking personal email may imply distraction and could potentially supersede all other evidence.

Preventing Distractions

Complex problems require a multifaceted approach. Organizations, teams, and individuals should all take responsibility and ownership for reducing the risks associated with digital distraction. The following risk management strategies can help prevent distractions and enhance patient safety.

Organizations

• Create awareness.
• Recognize the extent of the problem and risks.
• Model appropriate personal electronic device use behaviors.
• Tier communication to batch nonemergent messages.
• Refrain from sending texts on nonurgent matters.
• Do not expect immediate responses for nonurgent matters.
• Educate system-wide.
• Train all healthcare providers and staff at orientation, and conduct annual refreshers on safety concerns, legal risks of using personal electronic devices when providing care, device-user etiquette, and the addictive potential of technology.
• Introduce distractions as part of scenarios when using simulation-based learning for high-risk procedures.
• Introduce case examples featuring adverse events caused by distracted practice.
• Deploy technology solutions.
• Manage facility-issued devices.
• Create technology-free zones.
• Limit internet access to work-related sites only—electronic health record, labs, images, pharmacy formulary, state Rx databases, and decision-support/cognitive aids.
• Enforce.
• Monitor compliance with system-wide protocols and guidelines.
• Define and clearly communicate the organization’s policies regarding the use of personal electronic devices in patient care areas.

Teams

• Reinforce situational awareness and mindful practices with your team or department:
• Implement unit-specific protocols, such as the “Sterile Cockpit” and “Below 10,000 Feet” protocols that limit or eliminate nonessential activities during critical phases of procedures and high-risk activities.
• Empower team members to speak up when they have a safety concern. For example, encourage them to speak up when they notice that another team member is so focused on a personal electronic device he or she has lost situational awareness about the patient’s clinical condition.
• Apply TeamSTEPPS® principles: leadership, situational awareness, mutual support, and communication.
• Create a process that enables employees to be reached via a call to a central location, with messages relayed to the employee by a staff member. This alleviates employees’ desire to have personal electronic devices nearby in case of a family emergency.
• Monitor compliance as part of the team’s quality measures.

Individuals

• Take personal responsibility: Ignore distractions—especially during high-risk procedures—and make sure to speak up, set an example, and remain vigilant.
• Practice situational awareness:
• Pay attention to what is happening in the present moment.
• Increase attention, focus, and concentration.
• Leave your device behind.