Use of mobile phones in hospitals
BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38995.599769.80 (Published 12 October 2006) Cite this as: BMJ 2006;333:767
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Editor,
My title is a direct quote from Calcagnini et al[1], which I don’t
think has been cited before in your journal. Pro-cellular phone people may
say “no problem there”, while anti-cellular phone people may say “continue
the ban”. But all should have a plan as to how the distance of 30 cms can
be realised while the phone and the infusion device are both attached to
the patient, who is often not "critical care" in any way.
[1]Calcagnini G, Floris M, Censi F, Cianfanelli P, Scavino G,
Bartolini P. Electromagnetic interference with infusion pumps from GSM
mobile phones.Health Phys. 2006 Apr;90(4):357-60.
Competing interests:
None declared
Competing interests: No competing interests
I conducted a hospital vox pop of attitudes to mobile phone use and
found a large variation. What everyone had in common was a self-confessed
ignorance of the peer-reviewed literature on the subject. I was shocked to
find these authors behaving likewise. This articles is tiresome. As
Richard Brady has pointed out – it contains no systematic reference to the
literature, but a string of anecdote, hearsay and opinion.
Consider the null hypothesis. “Mobile phones can safely be used anywhere,
at any time in any part of any hospital, regardless of proximity to
therapeutic or life support equipment”. Let’s demand p < 0.05. i.e.
less than a 5% chance of an adverse event. The MDA bulletin would force us
to reject the null hypothesis. And contrary to myth, the phones tested in
the MDA bulletin included GSM i.e. current handsets. Modern handsets may
be dinky and appear to have long battery lives but the power required to
reach the nearest base station is governed by Maxwell’s equations and they
haven’t changed since the MDA bulletin. Furthermore, adaptive power
control makes it difficult to generalise the results of testing. A phone
in an operating theatre is probably broadcasting at maximum power in order
to penetrate the x-ray hardened walls.
To date, although mysteriously un-referenced by Derbyshire and
Burgess, the most comprehensive treatment of the subject of mobile phone
EMI and medical devices is by Lawrentschuk and Bolton(1). I shall not try
to summarise this paper but they likewise reject the null hypothesis in
favour of some form of proximity criterion – probably between one and two
metres.
The survey of the AAA alluded to was widely quoted in the media at
the time but involved one of the least scientific questionnaires ever
produced; yet even these highly biased respondents admitted to a total of
incidents that took them half way to rejecting the above null hypothesis.
It would be interesting to perform an experiment where an NHS
hospital offered the following deal. Staff may carry a mobile phone and
use it freely on the campus. But they would make no ingoing or outgoing
personal calls nor browse the web. This would of course include calls
related to the private medical sector. On the other hand how would
judicious use of low power DECT phones, wireless networks and paging
systems compromise communication ?
references
1.Lawrentschuk N, Bolton DM. (2004). "Mobile phone interference with
medical equipment and its clinical relevance: a systematic review.". Med J
Aust. 181: 145-9.
Competing interests:
None declared
Competing interests: No competing interests
The risks of interference with electronic equipment by stray
electromagnetic radiation emitted by digital mobile phone can now largely
be discounted. As a result, lifting of restrictions on their use in
hospitals (and similar environments) seems a reasonable plea (Derbyshire
SWG, Editorial, Brit Med J. 2006; 333: 767). Unfortunately, mobile phones
are no longer simple verbal communcation devices, but now sport an array
of multimedia devices, including still and video photography - together
with the ability to instantly transmit captured images. "Happy slapping"
(and equivalent) videos are examples of the uses to which phone videos can
be put, with display of the recording on "U-tube" with minutes.
Sadly, it is inevitable that blanket removal of the ban on mobile phones
will lead to their use to record intimate personal images and clinical
events by phone users who are not necessarily subject to the ethical
strictures of the professions.
The ban on mobile phones must remain in force (and be enforced) in
clinical areas, and the reasons for the restriction made explicit.
Competing interests:
None declared
Competing interests: No competing interests
With regard to the potential infection risk of using a mobile
telephone on hospital wards.
I have had experience of a number of bleep systems in a variety of
trusts during my training.
With changing working patterns of junior doctors, these bleeps are
passed between two or sometimes three sets of hands during an
average 24 hour period.
The bleep invariably requires manipulation to retrieve the number
to which the doctor is required to respond.
The responder is then required find a free 'land-line' at a busy
nursing station (not cleansed prior to each use, I am sure) in order
to answer the call.
This system breaks down if the number bleeped by the archaic
system was dialled incorrectly, or the 'bleeper' is now engaged, (or
has become bored waiting for a response, whilst the busy doctor is
waiting patiently for a telephone to become available at said
nursing station.)
In these cases, the whole sorry affair is often repeated.
Either way, it involves far more contact with a variety of devices,
more of which have been touched by multiple members of staff.
This may increase the risk of contamination, and, more importantly,
it may increase the chance that important information may never
reach it's intended recipient at all.
I feel certain, from clinical practice, that many more patients are put
at risk due to delays from unanswered, or mis-directed bleeps,
than are affected by cases of infusion pump (or other device)
interference.
Unfortunately, I am not aware of any strong evidence to this effect.
Competing interests:
None declared
Competing interests: No competing interests
Sir, I read with interest the editorial by Stuart WG Derbyshire et al
on the use of mobile phones in hospitals.
There is a growing trend in hospitals throughout the world to
incorporate mobile phones and other wireless technology to offer more
efficient, cost effective, and higher quality healthcare. Misunderstanding
of mobile phone systems, electromagnetic interference with medical
devices, and available management solutions, however, has led to a wide
range of inconsistent hospital policies. Recent reviews and commentaries
on the subject have provided inconsistent and in some cases factually
incorrect information that confuses the issue.
At one extreme, unmanaged use of mobile phones in areas where life
critical medical devices are in operation can result in atypical
situations that may place patients at risk. At the other extreme, overly
restrictive policies based upon speculation may deny benefits by acting as
an obstacle to technology. Overly restrictive policies may also not
address growing and legitimate communication needs of patients and
visitors in times of crisis. While it may not be feasible for hospitals to
manage every mobile phone handset that is randomly brought into their
facility without certain limits on use in areas where life-critical
devices are commonly in operation, restrictions are not usually necessary
throughout the entire facility. Restrictive policies are also better
facilitated when easily accessible areas are designated where mobile phone
use is encouraged. Controlled mobile phone systems for use by doctors and
staff for hospital-specific communication, by contrast, can operate
compatibly throughout the entire hospital facility with appropriate system
design and management, even in sensitive areas.
I therefore think a cautious and controlled use with respect to
reservations in specific premises in the hospital complex would not be
harmful.
I therefore see the use of mobile phones in hospitals as a welcome
change to enable better communication among health care professionals to
provide better quality of care for patients.
Competing interests:
None declared
Competing interests: No competing interests
While mobile phones are being condemned for their potential role in
cross
contamination as they are so rarely cleaned, how many other items in daily
use by physicians are regularly cleaned - stethoscopes, pens, glasses,
ties?
Let's not set standards for one particular item that cannot be applied
generally.
Competing interests:
None declared
Competing interests: No competing interests
I thank the other contributing authors for their interest and I
apologise for my confusion regarding the isolated case report of mobile
phone-related morbidity (1), this will be actively addressed. Despite
this, the case continues to provide clinical evidence which conflicts with
the stated “mythical” risks of mobile phone use in hospitals (2).
In addition to the previous points on infection control, whilst
hand hygiene measures are vital, in the absence of guidance on adequate
disinfection of these devices, the potential for the cross-contamination
of individuals or clinical environments exists. A ban is not advocated but
the provision of appropriate cleaning guidance may be required.
Very briefly, in regards to alleged cases of inappropriate mobile
phone usage, there have been a number of previous reports in the press,
but few are detailed in the medical literature (3). Further detailed
coverage
and exploration of individual cases is not appropriate for this brief
response, but it seems there is a role for the restriction of mobile phone
use during an operative procedure.
Globally, reports have stated that “alarmed at the flood of
complaints against doctors busy talking on the mobile phone in operation
theatres or while seeing patients, the West Bengal government has recently
banned their use in operation theatres and intensive care units”(4). This
marks a change in regional policy and may be very relevant to the current
ongoing debate in the operating/consultation room environments of the UK.
There are emerging issues for the current and future medical mobile
phone user, including that of patient data security and confidentiality
with the increasingly multi-functional “smart” mobile phones. It would
seem beneficial to evaluate the importance of these and other alternative
issues, in addition to the substantial and excellent coverage of the EMI
issue in the current article, prior to introduction of relaxed or flexible
restrictions.
1. Hahn IH, Schnadower D, Dakin RJ, Nelson LS. Cellular phone
interference as a cause of acute epinephrine poisoning. Ann Emerg Med
2005;46 :298-9.
2. Derbyshire SW, Burgess A. Use of mobile phones in hospitals. BMJ
2006;333:767-768
3. Lee E. Surgeon operated while on phone. South China Morning Post.
1999.
(in; Lam S. Call for Re-evaluation of Mobile Phones in Hospitals. Can J
Anaesth. 2002 49 (6):632-633.)
4. Bhattacharya K. Mobile phone and the surgeon - Is there a
controversy?. Indian J Surg 2005;67:53-54
Competing interests:
None declared
Competing interests: No competing interests
Hospital managers are right to be concerned about the impact of
mobile phone
use on the hospital's electronic devices. The telephone/TV system
installed by
each patient's bed is second only to the hospital car park as a source of
patient-
generated revenue.
Competing interests:
None declared
Competing interests: No competing interests
Richard Brady states "There is increasing evidence of doctors who
have fallen foul of local authorities for inappropriate or unethical use
of mobile phones. These events have led to governmental policy change and
severe disciplinary action in some cases." I am fascinated as to what such
uses might be and why they, presumably, are confined to mobile phones? I
think it is reasonable to assume that doctors will be well aware that they
should not use the cameras on their phones, so it must be something else.
Can we know what this evidence is and what policy change is being referred
to?
Competing interests:
None declared
Competing interests: No competing interests
Resurgence in memorial post-mortem photography?
During a night shift I was called to confirm an expected death of an
elderly male patient on an open ward. The relatives were expecting a
doctor to come and they got up to temporarily leave the bay when they saw
me arrive. As they were leaving I noticed one of them quickly take a
picture of the deceased with his mobile phone. The patient had a
nasopharyngeal airway in situ and had not yet been cleaned by the nursing
staff. I thought it was slightly odd behaviour and mentioned it to a
colleague who said that she too had seen a relative taking a picture of a
recently deceased relative using a mobile phone.
Photographs of the deceased, particularly religious leaders, are
still taken and distributed in other parts of Europe but not, as far as I
am aware, in the UK. Memorial post-mortem photography was once popular in
Britain in the Victorian era but photographs were generally formalised
with the patient being dressed up and often having their family included
with them in the photograph. They were not candid shots of an unprepared
still warm body. Are the incidents witnessed above relatively isolated? Or
is the relatively covert and instant nature of the mobile phone camera
allowing people to respond to a stress in a way that comforts them, but
our society still deems unacceptable and morbid?
Competing interests:
None declared
Competing interests: No competing interests