BlackBerrys Introduced to ICU
With candour rare for a physician, Dr. Chris O'Connor recalls the day he made a potentially fatal mistake. It happened at the Trillium Health Centre in Mississauga, Ontario's busiest community hospital - but it could just as easily have happened to any doctor anywhere. Trillium's intensive care unit was hopping on a cold winter morning in early 2005. It was peak flu season, and O'Connor remembers six nurses jockeying to ask or tell him something about their different patients. In one case, a woman on a ventilator had had a feeding tube inserted through her nose. The insertion is done blindly. Most of the time, the tube ends up in the stomach, but it can also lodge in a lung. A nurse in the scrum asked O'Connor to read the patient's chest X-ray to check. In the confusion, O'Connor missed the tube in the woman's left lung, an error discovered only after the patient had been fed a couple of times. "If the nurse hadn't picked it up, things could have been different," O'Connor says. "It really upset me - the patient could have died."
The woman recovered, but O'Connor, 41, was left with a nagging question: how had he missed something ordinarily so straightforward? He doesn't blame the nurses, who were just doing their jobs. "It was how we were working as a team: it was inefficient, it was disruptive," O'Connor says. "I figured there had to be a better way." Enter the BlackBerry. In August 2005, O'Connor and his colleagues started testing BlackBerrys in the hospital's 26-bed ICU, equipping all the staff with the portable email devices, including doctors, nurses, pharmacists, dieticians, and social workers. It broke a cardinal rule - everyone knows communication devices like cellphones and BlackBerrys are prohibited in hospitals because they interfere with sensitive medical equipment.
Except they don't. For one thing, cellphone power output is significantly lower today than it was a decade ago, when studies first suggested there may be a risk. Modern hospital equipment is also better insulated against radio frequency interference. (In fact, while most hospitals ban cellphones, they often allow security personnel to use walkie-talkies, which have over three times the power and so are much more likely to cause interference with medical devices.) "The truth is it's safe to use cellphones in most clinical environments, almost everywhere," O'Connor says. "The only meaningful exception to that is neonatal intensive care units and their temperature probes. You don't want them there." Trillium had an independent consultant assess its plan just to be sure, and remains cautious - forbidding BlackBerry use any closer than one metre from a bed.
Trillium's trial was a huge success. In a survey rating the BlackBerrys' speed, reliability, and physician response to critical issues, staff gave the program an average of 6.1 out of seven. Today, everyone in Trillium's ICU can send emails to anyone anytime. "We're the first in the world to connect a health care team like this," O'Connor says. "Can the BlackBerry save lives? I think, absolutely yes."
The need for better communication is undeniable. O'Connor cites a study that found communication errors are responsible for 37 per cent of medical mistakes committed in ICUs. He notes how a landmark report published in 2004 estimates that somewhere between 9,250 and almost 24,000 Canadians die every year in acute care hospitals from preventable injuries or complications.
The hope at Trillium now is to expand the program beyond its ICU day shift. "It's just become a whole lot easier to get a hold of people," says Dr. Gopal Bhatnagar, the hospital's chief of staff. "I'd love to be able to get it into every physician's hands."
Gone are the days when Trillium's ICU nurses had to page a physician if he or she couldn't be found. Overhead announcements on the public address system invariably were noisy, disruptive and the nurses could never be sure the doctor got the message.
Email is content rich, and so Trillium deliberately chose BlackBerry models without voice capability, since calling doctors on a cellphone requires them to stop what they're doing to take a call, and then find a pen or remember what the call was about. But with email, they can briefly glance away from what they're doing to read the message, and if it's not urgent, ignore it, knowing the details are safely stored for retrieval later on.
Trillium's ICU is much like any other. Flat-screen monitors at nursing stations track several patients at any one time: heart rate, breathing, blood pressure. With the hiss of pumped oxygen in the background, nurse Jodi Kernaghan goes over her tasks for the day. Kernaghan uses one of the communal BlackBerrys assigned to her when she's on duty. She whips it from its holster and scrolls through a list of who's on that day. "Life is so much easier now," she says. Paging doctors had been a "nightmare," but with the change, morale is up. "We know we're being heard. They have no choice but to respond because there's a time-stamp on [the email]."
Nearby, nurse Christine Marek-Besko agrees. She was "excited, but at the same time a little bit nervous. We thought that we have so much technology as it is, and here's another thing being added - would it make things more difficult?" In truth, says Marek-Besko, "it made things a lot easier, like the fact that we don't have to hunt someone down to get an immediate answer. Within seconds I can get an order stat, or I can get a pharmacist to come up quickly to reassess a med, or if there's a family in crisis, I can BlackBerry a social worker," Marek-Besko says. "I don't have to wait for them to call me back."
Dr. Neill Adhikari, a critical-care physician in the ICU of the Sunnybrook Health Sciences Centre in Toronto, believes Trillium has taken a "progressive view" on improving health care. The current widespread use of paging technology, says Adhikari, is "at the very least, pretty inefficient, and at worst I'm sure there are instances where delayed responses to pages has delayed care."
The Trillium program runs on a commercial wireless network operated by Rogers Communications (which owns Maclean's). It costs the hospital $16,000 a year to run the 39 BlackBerrys used in the ICU - roughly 0.1 per cent of the unit's annual budget. To reduce costs, however, Trillium likely will soon abandon the carrier to run the devices off its own wireless local area network, says O'Connor, who handles between 40 and 60 ICU-related emails a day. That will restrict the BlackBerrys' range to hospital grounds, but it will also cut annual costs by two-thirds.
In a rare moment of downtime, O'Connor pauses over a steaming cup of coffee on the hospital's main floor. He is filled with a boyish exuberance, eyes wide but clear, convinced others cannot but help follow Trillium's lead, that BlackBerrys cut down on communication errors and distractions, and most importantly, reduce the likelihood of killing patients with avoidable mistakes. At a time when virtually every second person on the street is carrying a cellphone or a BlackBerry, "We can't have medicine lagging behind the rest of society by, like, six or 10 years," O'Connor says. "We can't."
Maclean's January 1, 2007