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Rapid response to:

Mixed Messages

Medical myths

BMJ 2007; 335 doi: (Published 20 December 2007) Cite this as: BMJ 2007;335:1288

Rapid Response:

Re: PatientLine and phones

Can't say for sure if you are right suggesting it's all about who
gets the money, but the situation where I work(big city public teaching
hospital in QLD) in Australia is presumably similar to yours - enough to
compare at least. Here are some the cost related facts, and observations,
as I know them:

1] Each bed has a hospital supplied phone(HSP)-buttons on the hand
piece style.

2] The HSP works automatically to receive calls in – no cost.

3] Calls to the HSP are channeled through the ward reception, not
direct to the patient.

4] A purchase must be made to use the HSP to make calls out, and
debit system then applies.

5] The point of purchase for the debit system authority to make calls
out, is several floors away, in a private enterprise "shop", along with
other retailers.

6] The HSP does work for a limited number of “free” calls, such as
contact to get one's TV connected(about 9 AUD per day), and staff to staff
related numbers. Emergency alarm button systems independent of HSPs are at
each bed.

7] Patients make few out calls on HSP due to the inconvenient nature
of out call activation and costs.

8] About 95% of patients in the <60 years age group have mobile
phone with them, and use them with great variety in their compliance with
the edict to have said mobiles turned off in clinical areas. There have
been innumerable instances where the edict was corrupted by the patient
taking their mobile, together with their IMED® infusion device to a non-
clinical area to make a call.

9] The age group >80 years are generally neither mobile phone
users or owners in hospital.

10] The >80 years group are the most compliant with the edict to
turn mobile phones off, due to not possessing them in the first place. Yet
they are subject to any effects of mobiles caused by others.

11] The >80 years group do often use the hospital supplied phone,
in response to calls directed to the bedside by ward reception.

12] Distance from the hospital is a factor in Australia, and it is
not unusual for patients to come from “the regions” where consultants, and
indeed people, are hard to find. Relatives sometimes demand to be put
through immediately, because they are calling from “woop woop”(common AU
slang word denoting distant rural place), mindful of the pending costs.
This demand is discouraged, since clinical matters cannot be subject to
extra-mural competing interests. A call back at hospital expense is often
the best option.

13] About 98% of nursing staff have mobile phones, yet some nursing
staff members expect to use the reception and publicly funded nursing
time, to be put in contact with a spouse or significant other, for non-
urgent matters, using the hospital phones.

14] Mobile phones, with their electromagnetic radiation(EMR)
emissions vary enormously in design and capability, while the infusion and
other devices are almost completely under the control of hospital
purchasers, and manufacturers.

15] Complaints about invasion of privacy from both patients and
hospital staff, caused by the photographic and recording capability of
mobile phones do increasingly occur.

16] There are many well known electronically controlled devices, each
with alarm capability, hence each competing with mobile phone ring sounds,
operating at the bedside in non-critical surgical wards, and the number is
increasing each year:-

1. electronically positioned bed.
2. pressure sore prevention mattress
3. fluid infusion device(up to eight separate lines each with alarm)
4. analgesic infusion device
5. oxygen humidifier
6. vacuum dressing device
7. oxygen saturation device
8. blood pressure monitor
9. thermometer
10. sequential pressure anti-embolism stockings
11. odour controlling negative ion generator.

Distinguishing alarms from each of the above is often difficult, and
directional properties of alarms are non-existent. Yet nurses often
subscribe to the myth of distinguish-ability without any research

17] Patients are often drug affected by centralCNS drugs, and can
confuse sights and sounds to their own detriment. One recalls a case where
the patient heard her bedside phone, reached over to what her drugs led
her to believe was the hand set, only to place her hand into the opening
of the swinging lid of the poorly located, yet well intended, bedside
sharps container.

18] Doctors, lawyers, professors of physics, and such elite
professionals, are rare patients in public hospitals.

19] Doctors(anesthetists excepted) do not directly program,observe,
and document infusion rates and volumes on wards. They merely prescribe
them. Nurses do the rest. Doctors don't even have access to the drugs

20] Doctors as staff members, use mobile phones frequently, yet
responsibly, tempting the conclusion that the real reason doctors are so
confident about the safety of mobile phones, is their own wish to use such
phones, rather than a detailed appreciation of the general surgical ward

In conclusion, my guess is that even if the hospital could make money
from the liberalization of mobile phones, as your post suggests, that
would in no way mean that the total of the issues with mobile phones would
be resolved to the satisfaction of all. Some very important issues are
only camouflaged by EMR and cost considerations.

Competing interests:
None declared

Competing interests: No competing interests

26 December 2007
Phillip J. Colquitt
Self-employed - Public Australian Hospital