Friday, April 20, 2007

Oral Communication in the Wireless Era

I was shooting hoops with my son behind our garage, the other day. He demonstrated how ridiculous and old man can look next to an adolescent with spring-loaded knees and an eagle eye for the basket. It was humbling to say the least.

Our basketball setup is one of those portable units, set up right next to the garage. We were deeply involved in a game of “HORSE” when suddenly, just as I was planning a perfect “swish” from the corner, the electric garage door opened behind me. The sudden unexpected nature of this event startled me and I watched my perfect “swish” transition into an “air ball.” After the brief adrenaline rush subsided, my wife drove up and asked, “How’s it going?” with a big smile on her face – not realizing that her wireless transmission to the garage door mechanics had precipitated, at least in part, my basketball demise at the hands of my son.

It dawned on me that a similar event probably occurs daily in operating rooms and electrophysiology labs around the country with the advent of wireless implantable defibrillators. You see, both Medtronic and Boston Scientific have defibrillators that can communicate wirelessly with their respective programming computers. It’s a handy feature, in many respects.

But today, as I was replacing an older defibrillator with a new wireless model, a subtle, yet significant event occurred.

First, let me say that no one perished as a result of what happened. No one was initially aware that anything had even occurred. But I suddenly realized it.

At first, I became aware of a subtle background sound across the room: * tap * * tap * * tap * * tap *. I kept working and had just replaced an old defibrillator with a new wireless model. * tap * * tap * * tap * * tap * *tap *. And then I looked up at the monitor. Much to my surprise a dramatic change in the EKG characteristic was there. I hadn’t expected that. It seems the person controlling the wireless programmer was testing different parameters on the device quietly in the background and this person was pacing only one lead rather than both leads as part of the device checking process. This programming change dramatically changed how the EKG appeared to this startled surgeon.

Checking these parameters, by the way, is perfectly appropriate. Every device has a series of tests that are performed on the device to assure that it is receiving signals from the leads within the heart correctly, that no lead was damaged during the device change, etc. No, this was not my gripe. That’s what you WANT people doing.

What bothered me was the lack of verbal communication between the person performing those tests and the operating physician. You see, the doctor performing the surgery should know when a programming change is being made to their patient’s device, just in case something is NOT done correctly or if there was a problem discovered. It avoids that startled rush of adrenaline that occurs when the garage door suddenly activates without your knowledge. Doctors don’t like it when things happen they don’t know about while their operating on a patient. Trust me on this.

So if you are a device representative or nurse in a lab or operating room responsible for performing programming of any wireless device, let the doctor know what you’re about to do before you do it. Tell him something like “I’m going to test the threshold of the right ventricular lead now, OK?” and wait for the doctor to acknowledge he is aware that changes are being made. Always, always, always keep the oral communication going when wirelessly communicating with these new medical devices.

Doctors will appreciate it, and patients will certainly benefit.


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