Facebook in the ER

With the pervasive use of Facebook in work settings today, it should come as no surprise that logging onto social networks is just as common in critical-care hospital units. But for patients, this is troubling news.

A new study by researchers at the University of Florida Medical Center, recently published in the Journal of Medical Internet Research, revealed an “unacceptably high” level of Facebook surfing, especially during peak times at night in the emergency department (ED).

Erik Black, Ph.D., an assistant professor of pediatrics and educational technology at the University of Florida College of Medicine, led the study.

“We had anecdotal reports that Facebook use was prevalent in the ED. We did not know exactly how prevalent it was, or if it was an issue to be concerned with,” Black said.

As it turns out, the results of his 15-day observational study, conducted between late December 2009 and early January 2010, were worse than expected.

Black and his colleagues found that ED workers together visited Facebook more than 9,000 times—spending an average of 12 minutes per hour on the site. At night, when the ED is typically very busy, workers were on Facebook for nearly 20 minutes per hour.

The researchers measured the minute-by-minute volume of Facebook use on 68 workstations in a busy Level 4 trauma center, computers which were available to nurses, pharmacists, clerks, physicians, medical students, and residents, according to Black.  

Facebook use was compared with patient volume and clinical severity data during the same 15-day period. An “unexpected and significant positive correlation” showed that as the ED got busier, the staff sought more “time outs.”

Healthline News spoke with Robert Glatter, M.D., an emergency physician at Lenox Hill Hospital in New York City. “I am not surprised that the data demonstrated higher use of Facebook associated with higher acuity in a busy emergency department,” Glatter said. “Some medical providers who are quite adept at multitasking feel that these mental breaks lead to greater focus and productivity.”

But are the stakes too high?

Harmless Breaks or Compromised Patient Care?

Previous studies have shown that briefly engaging in tasks unrelated to work may have positive effects on worker fatigue and stress, while increasing productivity. “It is possible that these 'time outs' lead to improved worker functioning,” the study authors note.

However, in chaotic environments like the emergency room, the accuracy and speed of complex interactions among personnel can have a direct impact on patient outcomes.

Glatter expressed his concerns. “The often-described use of social media to 'vent' or take mental breaks in patient care areas associated with high stress has the potential to lead to bad patient outcomes,” he said.

“I personally believe that taking cognitive 'time outs' helps medical providers decompress during stressful periods in the ED.” At the same time, Glatter added, “Alternative means (other than Facebook) may be more judicious in such a high-risk setting.”

The Patient Privacy Factor

According to recent statistics from the Pew Internet & American Life Project, the average Facebook user has 648 “friends,” and the potential for a breach of confidentiality is high, according to Black. “Now, if we inadvertently disclose PHI (patient health information) on Facebook, we have disclosed it in a venue like a movie theater,” he said.

Since the passage of the Health Insurance Portability and Accountability Act (HIPAA), patient privacy has been an important legal liability for both hospitals and providers, and Glatter believes policies about staff use of social media should be stiffer.

Glatter says that “hospital EDs should strongly consider policies restricting use of social networking sites by medical providers while on duty. This should include smart phone access to Facebook in high-acuity patient care areas.”

As of now, some hospitals limit access to Facebook while others do not. Black said that his hospital allows unlimited access, whereas Glatter’s affiliate hospital, Lenox Hill, strictly bans the use of social media in patient care areas during working hours. “I feel that this is in the best interest of patients and their families,” Glatter said.

Black and his colleagues have more medical-setting research in the works. “Given the popularity of online social media and the propagation of smart phones, we’ve really got our work cut out for us,” he said.

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