Intensive Care: Q&A with Dr. Chris O'Connor, Director of Medical Informatics
Dr. Chris O'Connor is the director of Medical Informatics and a critical care physician in the Intensive Care Unit (ICU) at Trillium Health Centre in Mississauga, Ontario, Canada. As director, he is responsible for up to 35 staff—doctors, nurses, dieticians and other specialists—delivering intensive care on a 24-hour cycle.
Ongoing contact between members of the healthcare team is intrinsic to what Dr. O'Connor does—so much so, that a year and a half ago, frustrated by standard techniques of communication, he decided to try a new tack.
Since August 2005, Dr. O'Connor's unit has been test-driving 35 BlackBerry® devices to gauge how the device could be used to deliver care more effectively. (Dr. O'Connor claims his ICU is the first in the world to use BlackBerry devices in this way.) Just over a year into the study, the physician says he's beyond a convert—at this point, he cannot imagine life without his BlackBerry device.
In this Q & A with BlackBerry Connection®, find out the difference a BlackBerry device makes to the ultimate high-stakes performer, where effective instant communication can, quite literally, be a matter of life and death.
BlackBerry Connection: What was your eureka moment — in terms of realizing the device's potential?
Chris O'Connor: I remember the first time I gave an order over the BlackBerry [device]. It was a patient whose blood pressure was running very high—too high.
The nurse sent me an email about it, saying, “The blood pressure is too high. I'd like to increase his anti-hypertensive medicine to address this.” And I was looking at the message and I thought about it for a second and then I said, “yes, good idea, go ahead,” and I hit send.
I was actually stunned — I was struck by how easy it was, how effortless and fast. I had addressed the problem in infinitely less time than it would take me to go to a phone and try to get her paged.
When we first implemented the BlackBerry [devices] in the ICU unit, originally I thought that I would receive the messages and respond to them in the old-fashioned way. It never occurred to me that I could actually reply with orders and treatment. Once I did that first treatment, the benefit was blindingly obvious.
BC: How has your BlackBerry solution affected your work in the ICU?
CO: Communicating is fundamental to healthcare delivery. healthcare is provided by large interdisciplinary teams–physicians, nurses, dieticians, social workers, unit clerks and respiratory therapists. They're always busy. They're also always mobile – even if they are based on a floor, they are constantly in motion, moving from room to room, from patient to patient or to other areas of the hospital for tests.
If you can help these people communicate with each other faster, easier and more efficiently without interrupting them—well, that is a profound difference. That's why we have found the BlackBerry solution offers such a benefit.
BC: What was being done before?
CO: Like all hospitals, we used a combination of overhead paging, receive-only pagers, physically going to look for people, writing bits of information down on scrap pieces of paper and waiting for others to find them.
You have to interrupt what you are doing, go to the phone, dial the number, wait for whomever to pick up, then you would say, “it's Dr. O'Connor, I got paged.” And they will say, “let's check to see who it is.” You get put on hold while they find out who paged you. Often, the person who paged you isn't by the phone anymore, they are off doing something else. You have to then wait for that person to come to the phone, and they often don't have the patient chart information that you need at the time.
All of these methodologies have significant drawbacks. They are slow, they are disruptive, they are inefficient, they lack significant information content, they fragment the flow of information and ultimately they lead to an inefficient and dysfunctional healthcare team. Now, all I do is reply to email.
BC: What would you say is the most critical aspect of this greater efficiency, given you may at times be working in situations where getting the right information to the right person at the right time can be a matter of life or death?
CO: The core of our business is responding to the needs of our patients. If a patient's condition changes, the nurse at the bedside can now send information about that change almost instantly, and warn as many people in the healthcare team as need to know.
An appropriate response may range from coming to the bedside if it is urgent; forwarding the message to another member of the healthcare team; or simply responding with an email. This all happens in virtual real time.
It means the treatment of the patient can begin before I even see the patient.
BC: You've been using the BlackBerry devices mostly within the ward?
CO: We've been using it in the ICU. We have a 26-bed ICU, which covers a big area, and we have a large team of healthcare professionals, with 19 nurses working at a time. The total size of the team is around 35 people working in this large area.
BC: How do you see the BlackBerry devices being implemented elsewhere in the hospital?
CO: This device should be used everywhere, all the time. That's no understatement. It doesn't matter what healthcare setting you are in, the reality is that the ability to communicate effectively is central to our ability to deliver good care to our patients. This transforms our process. So it should be used everywhere.
BC: Have you identified certain other areas of the hospital that you'd like to see it rolled out in?
CO: We would probably next implement it in medical surgical wards. But truthfully, it should be everywhere. The obstetricians want to implement it in the birthing suite; the cardiologists want to implement it in the coronary care unit and on all the cardiology floors. The BlackBerry [solution] has been used in our ICU for over a year, so there's been an awareness in the hospital of it and people want it. There's a lot of demand across the hospital.
BC: Besides almost instant communication, what other aspects of the way the device works have you found useful?
CO: Using email this way, there is a time-stamped record. If I don't respond to the problem right away, I can refer to the email at a later date and that way I won't forget anything.
Before it was all verbal, it was either a phone message or a page. A nurse would say: would you mind checking the chest X-ray on patient Y? So I'd have to remember that as I'm wandering around doing many other things. With the BlackBerry [device], everything is recorded on the email. It is very clear: whose chest X-ray, what bed, what time. All the information is there and there's no chance of forgetting.
BC: Any parting thoughts?
CO: It is now remarkable to me, that in 2006, people are still using receive-only numeric pagers. It is the worst possible communication tool one can use, and yet it is the norm in medicine today. I still remember Pager Liberation Day: the day I released my pager and it sailed down to the bottom of the garbage pail and I never saw it again. That was fantastic and I have never looked back.
News coverage of the Trillium Health Centre ICU trial:
Global News – “BlackBerries saving lives in hospital experiment” (Video feed)
Toronto Star – “Hospital catches BlackBerry fever”
Canadian Healthcare Technology – “Wireless BlackBerry transforms communication at Trillium's ICU”
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