Hospitals hang up on cell phone restrictions

Did you hear about the 4-year-old girl who died during routine surgery when her life-support equipment went kaput because some jerk outside the OR was yakking on his cell phone? It never happened, according to Snopes.com, which debunks widely distributed urban legends like this.

To the contrary, new evidence shows that the wireless devices are now much less likely to interfere with medical equipment, prompting many hospitals to loosen once restrictive cell phone use policies.

More than 80% of hospital engineers who responded to an online survey earlier this month said their facilities allow cell phone use in nearly all parts of the hospital, up from 56% in the same survey in 2004. Fifty-five percent of respondents said their hospitals' cell phone policies had been relaxed within the last three years.

While complaints about patients' bad cell phone manners abound, many physicians welcome the policy change because they say it allows them to communicate more efficiently, improve the quality of care and stay in touch with their offices while making rounds.

New papers published in the British Medical Journal and presented at the American College of Emergency Physicians' meeting last month are the latest to buttress what has become conventional wisdom within the biomedical engineering community since the late 1990s.

Improved magnetic shielding in medical equipment, lower-wattage digital-era cell phones and the plethora of cellular towers mean that the risk of electromagnetic interference is low and rarely of clinical significance. It usually amounts to nothing more than a blip on a monitoring device's screen.

The change in hospital policy is a long time coming, says A. "Andy" Joseph Anderson, MD, lead author of the ACEP paper and a chief resident of emergency medicine at the University of Mississippi Medical Center in Jackson. He became interested in the issue when a police officer ticketed the wife of one of his patients for using her cell phone in a hospital hallway.

"These cell phone bans started in the early 1990s," Dr. Anderson said. "They have not really kept up with technological advances. I believe they're now antiquated."

Risks present, but rare

In the early days of cell phones, some physicians lugged around bulky units that emitted as much as 3 watts of power. Today, cell phones may emit up to 600 milliwatts, or six-tenths of a watt. Typically, though, they emit as little as 250 mW to 300 mW. Meanwhile, the Food and Drug Administration has worked with medical device manufacturers to reduce the risk of electromagnetic interference from wireless devices by enforcing stricter electromagnetic compatibility standards and testing processes.

An October 2005 Mayo Clinic Proceedings study found that in more than 500 tests of different cell phones and medical devices, there was clinically important interference in only 1.2% of cases. Types of interference included equipment displaying an incorrect value, alarms sounding, and wrong electrocardiogram flatlines, signal noise or baseline movement.

The Mayo Clinic in Rochester, Minn., now allows cell phone use everywhere except critical care areas such as ICU or OR, according to Jeffrey L. Tri, lead author of the Mayo study and an electrical engineer there. A new round of tests has been analyzed and submitted for publication and could provide the evidence needed to do away with even that restriction.

"The decision eventually comes down to the question of whether the benefits of using the technology outweigh the risk," Tri said.

Cells quicker than pagers

The answer to that question is clear to Roy G. Soto, MD, associate professor of anesthesiology at Stony Brook University School of Medicine in New York. Dr. Soto and his colleagues surveyed more than 4,000 attendees at a 2003 American Society of Anesthesiologists' meeting and found that physicians who used cell phones were 30% less likely to have experienced a delay in communication than were those who used pagers.

"If a 12-year-old kid gets in trouble, he can use his cell phone to call someone for help," Dr. Soto said. "But what if I need immediate help to save someone's life? ... It just seems like a no-brainer. We should have communication that's just as efficient as what everyone else has."

Dr. Soto said policies are self-defeating when they don't allow cell phones in critical care areas, yet allow them everywhere else as long as people stand a few feet away from medical equipment.

"Restrictions make the least sense in critical care environments because that's precisely where communications are critical," Dr. Soto said.

Staff, patients have different needs

Dr. Soto suggested a different policy: Allowing physicians and medical staff to use cell phones in critical care areas but restricting patient use.

While some hospitals have found such dual-track cell phone policies untenable, Dr. Soto's co-author, Keith Ruskin, MD, noted that "doctors are allowed to do a bunch of things that patients are not allowed to do."

Dr. Ruskin, associate professor of anesthesiology and neurosurgery at Yale University School of Medicine, said he believes it would be "hard for a patient's family member to complain if I'm on the cell phone discussing blood-gas values in the operating room. Now, if I'm just hanging around in the ICU talking to my stock broker, that's not good."

Also not good, said cell phone booster Dr. Anderson, is how patients abuse cell phones. He has had patients attempt to continue a phone conversation while he takes a history and physical.

But failure to display common courtesy, Dr. Anderson said, "is not limited to cell phone usage." A teenage patient "was more interested in getting to the next level on his Game Boy than talking to me."