Patient-Centered Care in the Digital World

2016 - 4 August- Clinical Controversies Highlighted at the 45th Critical Care Congress
Peter J. Papadakos, MD, FCCM, FAARC
Discover ways to combat electronic distraction in the ICU.
As our world has become more and more an environment populated with digital devices, where humans interact with these devices hundreds of times a day, a new problem in the healthcare field must be addressed. Data from studies regarding distracted driving can easily cross over to healthcare providers and their interactions with patients. A current study from the Pennsylvania Research Center clearly illustrates a generational fixation on smartphones. The study found that 92% of teenagers reported going online “almost constantly.” This is not only a problem with teenagers. A look around any healthcare facility will reinforce that healthcare providers are also greatly affected, because they too are fixated on their devices. This shift in human behavior has left us ill prepared for how individuals interact with technology, which is labeled “human-to-technology interfacing.” Hospitals have spent billions of dollars during the past five years on the introduction of electronic medical records (EMRs). Many hospitals have also become fully digital, using wireless technology to improve communication among staff through the use of tablets, while helping to improve education and provide interaction with EMRs.

All of this technology may affect how we safely practice medicine and interact with patients in a humanistic manner. A 2011 New York Times article by Matt Richtel on “distracted doctoring” pointed out that there was indeed a rising crisis. The commentaries on this article also bring to light the widespread feeling by patients that they were no longer at the center of the healthcare system. Caregivers were not making eye contact with patients and their families. They had become so-called “iPatients,” a term that in itself dehumanizes patients. There have also been a number of malpractice occurrences in which the core problem was a distracted caregiver. The caregiver was using a personal smart device and was not focused on patient events.

We critical care providers in the fluid environment of the intensive care unit must be at the forefront of changing this dangerous, dehumanizing behavior. We should take our lead from the similar environment of the operating room, where physicians and nurses have begun to develop educational programs to address these issues. In our center, we orient staff on how to balance professional versus personal use during the workday. We point out the levels of distraction and possible addictive properties these devices project onto our daily life. It opens up discussion of the proper place and time for the use of texting and social media during the workday. We also must educate caregivers about how to balance electronic charting with actual human interaction.

During our patient rounds, we should try to decrease the electronic footprint. The critical care team must be able to discuss data without the distraction of individuals staring at computer screens. In my practice, we have one computer for images and laboratory data, and one for order writing. Thus, everyone is focused on that specific patient at that specific time. This also addresses safety issues such as writing the wrong order for the wrong patient. The team leader who has no device is free to interact with patients and families during rounds.

I am hopeful that critical care providers will begin the task of both education and research as to how distraction in a digital world can be addressed.