Cell Phones in the OR

How do you guys deal with pagers/cell phones in the OR? Our residents/fellows used to have pagers and it's in our unwritten policy manual to answer their pagers for them. Fine, I can deal with that. Recently, our hospital converted the pagers to cell phones instead. So instead of hearing the annoying beeping, the cell phones are going off constantly throughout the case. With the pagers, at least I can turn them off and have the option to answer the page when I have a minute. Now, with the cell phones, I have to stop what I am doing to answer their cells. And every time you answer the phone, the calling party is ALWAYS surprised that so and so is scrubbed. HELLO????? That's what surgeons do! Sorry .... I just have to vent.

I am going to get some flak from younger nurses for this, but here you go:

THE CIRCULATING NURSE IS IN CHARGE OF THE ROOM.

TAKE CHARGE.

In my rooms, the residents know better than to bring a beeper or cell phone into the room. They leave it at the front desk, or they don't scrub in.

If they want to whine about it before they have gotten used to the routine, they can take it up with the attending.

He will back ME, or any other circulator, not some resident whose time there is brief.

He will likely validate what I have already told them by saying, "She is right, you know. You need to delegate whatever unfinished duties you have, or potential ones, to one of the medical students under you, or to another resident.

If you cannot give this patient your undivided attention, then perhaps you should not scrub in until you can."

My responsibility in that room is to advocate for that patient--not to answer phone calls about other patients. Docs cannot simultaneously operate and tend to floor patients or ER patients, trauma or no trauma. Those duties need to be delegated, or they should not scrub in. Period.

You should not even have to take this issue to OR management.

YOU, not management, are in charge of your room. People will abuse you only as long as you allow yourself to be abused. Expecting you to answer their beepers or cell phones is an abuse of what they perceive to be their power, and it is inappropriate and also disrespectful of the patient on the table. You notice that attendings rarely, if EVER, do this--they respect us too much.

Shodobe, let's hear your thoughts.

I agree that cell phones are becoming a nusiance. We have a couple of OB docs who use their phones exclusive for contact. No matter where they are you have to call them on their cell phone. Now, this can be good in some repect because they will answer you 99% of the time. The pager they can ignore and you are never sure if the page goes through. For pagers and cells in the OR, I will usually answer pages for the surgeons if I am not busy. Cell phones, I suddenly become deaf! I will ignore cells because the guys that use them are not high up on my list of favorites and they usually leave them in their coats at the desk so I can't hear them anyway. Most of time they will tell you so and so is looking for them and could you please answer when it rings. They ask nicely so it isn't a problem. I would definitely get upset if I was answering pages and phones for a bunch of residents. Someone is always looking for them so their electronics would be constantly going off. They should leave at the desk where someone who isn't busy can be their secretary. Mike

I agree that cell phones are becoming a nusiance. We have a couple of OB docs who use their phones exclusive for contact. No matter where they are you have to call them on their cell phone. Now, this can be good in some repect because they will answer you 99% of the time. The pager they can ignore and you are never sure if the page goes through. For pagers and cells in the OR, I will usually answer pages for the surgeons if I am not busy. Cell phones, I suddenly become deaf! I will ignore cells because the guys that use them are not high up on my list of favorites and they usually leave them in their coats at the desk so I can't hear them anyway. Most of time they will tell you so and so is looking for them and could you please answer when it rings. They ask nicely so it isn't a problem. I would definitely get upset if I was answering pages and phones for a bunch of residents. Someone is always looking for them so their electronics would be constantly going off. They should leave at the desk where someone who isn't busy can be their secretary. Mike

That's another good point--I know if I sit in front of my computer and my cell phone goes off, all kinds of weird artifacts show up on my computer screen, as well as a lot of weird noise.

I have seen the same phenomenon in operating rooms where a cell phone that was inadverdently left in a lab coat started ringing--the video monitors, the cautery, the datascope all of a sudden start showing weird artifacts and making weird noises.

In some hospitals, cell phones simply will not work--period--inside the building.

I have actually worked with one attending who wore an earpiece attached to the cell phone in his pocket. I don't have a problem with that--he is handling his business, and, as long as it does not interfere with the monitors, or the care of the patient on the table, it's fine.

I don't think residents, however, have the skill necessary to operate and talk on the phone at the same time, so that is not something that would be acceptable in any room I am in. If management was to call me in and tell me I had to answer residents' cell phones or beepers, I'd say he** with it and go elsewhere. That's the beauty of being a traveler. However, it has never happened. Management wants to talk the talk of patient advocacy, they had better walk the walk too.

I don't understand why the hospital has decided to replace beepers with cell phones. I know cell phones are not allowed to be used in the ICUs, but it's OK in the OR? It doesn't make any sense.

We don't have a place for the docs to leave their pagers/cells. There's a case cart in the room and everyone usually just leave all their pagers/cells on top of the case cart before they go scrub.

I'm just going to have start telling the residents to put their phones on vibrate so their phone calls won't be disrupting the room during surgery. However, there's not much I can do about attendings, especially with the transplant service. The transplant coordinator calls all the time regarding possible organs available, then the attending wants all the details about the possible donors. I love my job in the OR but I hate being a secretary.

Here's a workable suggestion: Aren't there any med students rotating through the transplant service? Delegate the "beeper-cell phone" duty to THEM. That is your right. Tell the transplant team before they scrub in that they need to delegate either an intern (who obviously is not an intern that will be scrubbed) or a medical student to run back and forth relaying messages between the transplant co-ordinator and the scrubbed attending.

I've worked in 3 different facilities where we did transplants of every sort, and never once has an attending suggested I was out of line for telling the rest of his team that I "don't do cell phones or beepers, so leave them at the desk or make other arrangements." Usually, the transplant co-ordinator was an RN anyway, and very respectful of the other RNs, so she would simply come into the room to discuss other matters with the scrubbed attending.

Even as a traveler, where there could have been a possible power play exerted because I was not a staff RN, it didn't happen. The attending on any case wants an assertive circulator, as a circulator who will speak up on her own behalf is a circualtor who will speak up and demand the best care for the patient on that table. In the case of cell phones and beepers in the oR, that circulator is addressing both issues simultaneously.

I have to say the cell phones dont bother me too much at all. Usually only the res on call has one and we know its 99.9% a call re a patient. As for the monitors, the cell phones dont bother them at all. I agree with another post its so much faster to get hold of a member of the team when their out of the OR by calling them on the cell rather then the pager therefore how can I begrudge someone else trying to get hold of them?

I have to say the cell phones dont bother me too much at all. Usually only the res on call has one and we know its 99.9% a call re a patient. As for the monitors, the cell phones dont bother them at all. I agree with another post its so much faster to get hold of a member of the team when their out of the OR by calling them on the cell rather then the pager therefore how can I begrudge someone else trying to get hold of them?

You are very lucky. Here, there might be 3 or 4 residents scrubbed in, and they each carry, at times, 2 beepers and a cell phone.

The reason they have 2 beepers is that they are assigned one by the medical school and the hospital affiliated with the medical school through which they are doing their residency; the second one is given to them temporarily by the hospital at which they are doing their current surgical rotation (ours.)

Their cell phones are often personal ones, for their wives or girlfriends to reach them. At the same time, the room phone is ringing constantly with calls that have been put through from the desk, from the floor nurses for those people.

Normally, they would not have been put through, except the floor nurses have convinced the desk the matter is urgent. The "urgent" matter is 99.99% of the time one that can WAIT until after the surgery is over, and could have been solved by the med-surg nurse doing a little bit of critical thinking on her own.

In our OR: NO CELLS (except packed cells) :chuckle

I try to take pagers away from the docs as they enter my OR, I will gladly answer their pages and take a message, relay messages, etc. WHEN I HAVE THE TIME. The pt on the table comes first, unless it's some sort of code or trauma type thing.

A few docs carry cell phones instead of pagers. They stay out front with the secretary. She answers these. She will then relay them to me. For the most, cell phones don't work in the OR.

Once in a while, you get a rep. carring one. They usually turn them off, but some have such a big territory, the few calls they get, I don't think are an issue.

During the day we ask docs to leave their pagers outside of the room, unless they are "on-call" If I am really busy I will contact the operater and inform her that he/she is in surgery and to let callers know that they may not get any immediate response. When we are on call we always answer pagers/cell phones. We have not found any interference with cell phones with our equipment. Ruby

I dont answer cell phones! That's why they have voice mail.

Interesting story. I had a CRNA getting ready to put a patient to sleep and his cell phone started ringing. We were just doing the pre-oxygenation thing. HE ANSWERED IT!!! "Yeah, I know...can't talk right now...." and the patient yells "YEAH he's kinda busy!!!!"

Oh how sad that people can't control themselves.

Maybe I"ll bring that up in our next inservice, to ban cells in the OR....leave in a box at the front desk.

bmj 2003;326:460-461 ( 1 march )

editorials

mobile phones in hospitals

are not as hazardous as believed and should be allowed at least in non-clinical areas

mobile phones (cell phones) are a source of irritation for some but undeniably useful for many, and over 50% of the population of the united kingdom possess one. their use in hospitals, however, is mostly banned as they are considered potentially hazardous in medical environments. but the evidence for serious harm is flimsy, and the hysteria that surrounds the use of mobile phones in hospitals is unjustified.

so how dangerous are they? the evidence for harm is limited. anecdotal reports exist of interference with medical electrical equipment, 1 2 which led to a study by the medical devices agency in the united kingdom.3 in this study, 4% of medical devices suffered from electromagnetic interference from digital mobile phones at a distance of 1 metre. this compared with 41% from emergency services' handsets and 35% from porters' handsets. most of the interference related to disturbance of the signal on monitors, such as electrocardiographs, confirmed by data from the united states.4 ...............................................................(continues)