I was in one of my hospital’s operating rooms the other day checking out a malfunction on a surgical video system. By chance, the company’s sales rep was there on a call as well. As he assisted me with troubleshooting, he pulled his Treo™ off his belt and called his tech support. Imagine my mixed emotions—I was being assisted by a very helpful vendor, and I was also the hospital’s radiofrequency (RF) safety officer. We were well within 1 meter of several actively functioning surgical systems. Needless to say, I did not immediately order him to shut down his phone; we stepped back from the equipment so as to give 1 meter of clearance. I gratefully accepted his help and his free loaner equipment and never said another word about his cell phone use. Something about “not biting the hand that gives you help and free stuff” and such. …
In any other circumstance, who would have the heart to interrupt a cell phone conversation as a family member was relaying some very emotional news?
Controlling cell phone use in hospitals is becoming yet another item in the wardrobe of the “emperor’s new clothes” in the hospital industry. Signage, policies banning cell phones, restricting their use to certain areas—all of these are, in my humble opinion, placebos at best. Cell phone policy discussions are one of the recurrent hot topics on the Internet discussion forum “BIOMEDTALK,” and for good reason.
In reality, the floodgates are open, and we will never get them shut again. Cell phones are, without a doubt, the “crack cocaine” of the technology world. I have found myself working in care areas with my own cell phone in my lab coat pocket. I now have a new NEC microcell phone supplied to me by the hospital communication department. I am completely hooked on it at this time and would never give it up willingly. I cannot imagine being a patient or family member in crisis, or a doctor juggling office and hospital duties, without having a cell phone at all times. Caregivers working long hours need to stay in touch with families outside of the hospital. Vendors providing both critical and ancillary services also need cellular communication. The “need” for cellular phone technology is without question. And, not only do we need to consider cellular communication, we also need to consider Wi-Fi—a subject for another article.
At this point, we as an industry need to focus on risk avoidance, due diligence, and defensive biomedical engineering. To that end, I would suggest the following be considered when addressing cell phone issues in your facilities.
• Review your inventory—identify medical devices that are not likely to meet IEC 60601 RF immunity standards. Remove and replace them with equipment that is designed—in theory—to be immune to RF interference. Base this plan on risk, start with the old Baxter pca-2 type stuff, and move on from there.
• As you do with material safety data sheets, require and compile a library of declarations of conformity (DOC) on all electrical equipment in the care environment. Maintain the library for reference at all times.
• Make it policy that any vendor who cannot provide a DOC (or equivalent) cannot sell to the hospital.
• Install a distributed antenna system with bidirectional amplifiers at the head end for each of the major cell carrier system frequencies in your area.
• Educate staff and caregivers, and implement signage touting the 1-meter rule about cell phone use near functioning medical devices. Have a comprehensive education and public relations plan to promote responsible cell phone use and etiquette.
• Appoint an active, well-qualified RF safety officer, and implement comprehensive and reasonable polices. Obtain the necessary “buy in” to your RF safety policy from all possible affected entities within your facility.
• Demonstrate that you have done “due diligence”; have a sound risk-avoidance strategy in place; and involve risk management, the safety committee, and your compliance officer in the program.
• Address all types and modalities of personal wireless devices in your plan.
• Have an accurate, comprehensive RF registry or inventory of all emitters. If possible, overlay locations on the master computer aided design building plan of your facility.
I am in the process of doing all of the above—wish me luck.
J. Scot Mackeil, CBET, works at Jordan Hospital, Plymouth, Mass.