Danger signals

Much confusion still exists surrounding the potentially detrimental effects that mobile phones may have on medical equipment in clinical settings despite the latest Government advice.

It has long been suspected that mobile phones can interfere with medical equipment. In 1994, the Department of Health (DoH) issued a bulletin stating this possibility, leading to many hospitals introducing a total ban on the use of mobile phones on their premises. Further research conducted by the then Medical Devices Agency (MDA) indicated that mobile phones signals when used in close proximity have the potential to affect certain hospital equipment such as ventilators, infusion pumps and pacemakers, possibly altering  flow rates, or in some circumstances, even switching them off completely.

In another MDA study of the effect of a wide range of radio handsets on 178 different models of medical devices showed that 23% of devices suffered electromagnetic interference (EMI) from handsets, and in 43% of these interference incidents there would have been a direct impact on patient care, which were classified as ‘serious’.

The MDA findings also indicated that even when a mobile phone was in the stand-by mode it was still theoretically possible to create problems for hospital equipment as the handset continues to emit signals which enable telephone networks to locate it. Another possible problem concerned the triggering of fire alarms, a false alarm invariably causes panic and confusion in hospitals, resulting in unnecessary inconvenience to patients and staff alike. All this made it imperative that the use of mobile phones on hospital premises was strictly policed to prevent any of these incidents occurring, but now new recommendations seem to be indicating that they not be as hazardous as previously believed.

According to the latest advice from the Medicines and Healthcare products Regulatory Agency (MHRA), a balanced approach is necessary now to ensure that all the benefits of mobile wireless technology can be made available to healthcare organisations. Furthermore they state that much misinformation on these systems has lead to a broad range of inconsistent policies, and so they now recommend that healthcare providers should actively manage the use of the radio frequency spectrum in their own sites. This includes considering areas where medical devices will not be affected and need no restrictions, and other areas where authorised staff can use approved communication devices.

The MHRA recommendations cover a wide range of communication systems and categorise them into high, medium and low risk groups, depending on the amount of EMI they emit. High categories include analogue emergency service radios and the types of two-way handsets that porters may use, the MHRA recommends that these are either only used in emergencies, or that their risk is minimised by changing to lower risk technologies.

Mobile phones, laptop computers, palm pilots and gaming devices fall into the medium risk category, and here the advice is that a total ban on these systems is not required and is impossible to enforce effectively. However the MHRA further recommend that these systems should be switched off near critical care or life support systems, in particular Intensive Care Units and Special Care Baby Units, but can be permitted in certain designated areas.The final low risk category covers cordless telephones and certain computer radio networks, these are considered as very unlikely to cause interference and need not be restricted. 

The MHRA also notes however that the risk of interference is not the only reason why hospitals should limit the use of mobile phones, these other reasons may include the disruption caused to patients who are resting, the possible disturbance of professional discussions, where alarm tones on medical equipment may be overlooked because of confusion with other telephone ring tones, and where the use of camera phones may compromise patient confidentiality.

 The MHRA conclude that over-restrictive policies can act as obstacles to beneficial technology and may not address the growing need for personal communication of the workforce, patients and visitors. They also warn however that the unmanaged use of mobile communication  can potentially adversely affect some medical equipment to place patients at risk, and therefore recommend that hospital Trusts develop local policies to minimise the risk of interference with critical medical equipment.

In the wake of these latest MHRA recommendations, many health professionals now believe that the time is now right for a more rational approach to the use of mobile phones in hospitals. The latest evidence shows that the temporary and  localised effects of mobile phones towards medical devices such as patient monitors or pacemakers is transitory and can be alleviated completely by the removal of the mobile phone from its proximity to the equipment.

From the patients’ viewpoint however, mobile phones can play an important role in their treatment and care. Many patients suffer significant isolation while in hospital, and are unable to contact their relatives or businesses to inform them about their condition, or when they may be discharged. Relatives also need to contact others, as clinical situations can change or important information needs to be relayed to family members. Furthermore the provision for patient and relatives’ phones on wards is often inadequate and only goes some way towards addressing patients’ needs. Mobile phones used in the right environment would therefore go a long way towards relieving these additional stresses. Some clinicians are already calling for the current widespread ban on the use of mobile phones on hospital premises to be lifted on the grounds that it actually increases the risk to patient care.

Mobile phones and other voice and text messaging systems, if introduced, would be more efficient than the current out-dated bleep and pager systems in general use, which actually force clinicians to leave the patient bedside and find the nearest hospital telephone. Not only can this cause delays to treatment but the interruptions could lead to possible mistakes involving drug prescriptions and blood sample labeling, which may have serious consequences for the patients involved later.

Although it still seems prudent to continue to prohibit the use of mobile phones in hospital clinical areas inline with the MHRA recommendations, there is no reason to believe that their use on selected areas such as corridors, waiting areas and other similar public places should result in any detrimental effect to patient care.

One London hospital – the Chelsea and Westminster - already has a more relaxed approach to the use of mobile phones with the result that patients and visiting relatives now find the ability to use the mobile phone in selected areas invaluable. And for healthcare staff who need to communicate quickly to improve patient care, it is now becoming vital that these systems are adopted sooner rather than later. One solution could be to issue authorised equipment for healthcare-specific communication only, to allow the full benefit of wireless technology. But with an ever increasing percentage of the UK population now in possession of a mobile phone, their use has now become an accepted part of normal daily life, and consequently it seems that the current highly restrictive approach to the use of mobile phones on hospital premises needs to be urgently reviewed

By Barry Hill.
Barry has worked within pathology for over 30 years, and is a former member of the IBMS Blood Transfusion Special Advisory Panel.