Abstract
Background:
Healthcare providers use smartphones for various beneficial purposes, including education, communication, and remote patient monitoring. However, concerns have arisen about their potential to distract anesthesiologists in the operating room, potentially leading to catastrophic consequences. This study aimed to assess smartphone habits and attitudes among anesthesiologists at a tertiary care hospital in Riyadh, Saudi Arabia.
Materials and Methods:
A cross-sectional survey was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Anesthesiologists were surveyed using a questionnaire distributed via email and phone numbers. Hard copies of the questionnaire were also distributed in the operating rooms. Data are cleaned in Excel and analyzed using IBM SPSS 29.0.
Results:
Our study included 123 participants, mostly male (n = 102, 82.9%), with a significant portion aged 31–40 years (n = 34, 27.6%). Most were consultants (n = 51, 41.5%), and 64.2% (n = 79) spent less than 25% of their working hours on smartphones. Despite 52.8% (n = 65) reporting distractions from smartphone use, only 29.3% (n = 36) supported restrictions in operating theaters. A significant association was found between age and perceptions of smartphone impact on patient care (P = 0.012), with younger anesthetists more likely to see a positive effect. Moreover, frequent smartphone users were more likely to perceive benefits in patient care (P = 0.038), and those not distracted by phones believed that smartphone usage improved care (P < 0.001). Finally, those not irritated by colleagues’ phone use were more likely to report positive impacts on patient care (P < 0.001).
Conclusion:
Our study highlights the pervasive use of smartphones among anesthesiologists, with many acknowledging both benefits and distractions. While a significant number perceive positive impacts on patient care, concerns about distraction remain, indicating the need for balanced guidelines in operating theaters.
Keywords: Anesthesiologists, patient care, smartphones, survey-based study
Background
Smartphones have become an indispensable part of daily life for many healthcare providers. Healthcare workers are increasingly using medical smartphone applications for a variety of beneficial purposes. They allow the acquisition of online educational material and the ability to transfer and share information,[1,2] which has been reported to enhance the quality of patient care and reduce the incidence of medical errors.[3] Also, cell phones in healthcare allow for the ability to monitor patients remotely.[1] Furthermore, smartphones allow clinical performance evaluation by recording and maintaining online logbooks of clinical activity, thus becoming an asset for teaching institutes. Moreover, smartphones allow for enhanced communication between the medical team, which increases collaborative working and multitasking abilities.[4,5] Additionally, smartphones capture interesting diagnostic images or record procedural videos, which can be used for academic purposes.[6]
On the other hand, disadvantages of using cell phones include distraction in workplace settings[7,8] and impairment of working memory and recall.[9]
Anesthesiologists have great access to their smartphones while working in the operating rooms (ORs), especially during the maintenance phase of anesthesia, in which they perform monitor checks at short intervals, which, in stable cases, occupy 5% of their overall time.[10]
With various publications on smartphone usage among anesthesiologists, there has been increasing concern about nonmedical smartphone use by anesthesia physicians[11,12]; this can lead to catastrophic consequences, especially since monitoring anesthetized patients is a job that requires multitasking and maintenance of situational awareness.
Despite concerns about smartphone use among anesthesiologists, no study has yet evaluated the impact of smartphone use on anesthesia-related outcomes[11] as there has been no clear-cut answer to whether smartphones are distracting or helpful devices during working hours. This study aimed to observe anesthesiologists’ habits and attitudes regarding smartphone use in the OR through a questionnaire-based survey in a tertiary care hospital in Riyadh, Saudi Arabia.
Materials and Methods
The study was conducted at King Abdulaziz Medical City, a teaching tertiary care center that began operating in May 1983 in Riyadh, Saudi Arabia. The study included all anesthesiologists (residents, fellows, assistant consultants, associate consultants, and consultants) and excluded anesthesia technologists and technicians. We adopted the quota sampling technique by dividing the population into subgroups according to physician level and calculating the sample size for each subgroup to ensure that the sample represents the population proportionally. The sample size was calculated with a prevalence of 50%, a margin of error of 5%, and a 95% confidence level. The total sample size was calculated to be 123 participants.
We started distributing the surveys after gaining the Institutional Review Board approval from King Abdullah International Medical Research Center. The data collection process started from January to February 2024. The questionnaire was distributed as a Google Form link to all anesthesiologists’ emails and phone numbers; furthermore, the survey was distributed as hard copies to anesthesiologists in the ORs.
The questionnaire was based on a study by Smith et al.[13] that explored cell phone use by perfusionists during cardiopulmonary bypass with some added items according to our literature search.[14,15]
The data were analyzed in Statistical Package for the Social Sciences (SPSS), version 29.0. The descriptive statistics for the categorical variables are reported as numbers and percentages. Comparisons between categorical variables were calculated using a Chi-square test of proportions or Fisher’s exact test in the case of small samples. The level of significance was set at P value < 0.05 for all tests.
Results
Our study included 123 participants, with the majority being male (n = 102, 82.9%). Most participants were between 31 and 40 years old (n = 34, 27.6%), followed closely by those aged 20–30 (n = 33, 26.8%). The professional group was predominantly consultants (n = 51, 41.5%), while residents constituted 30.9% (n = 38). A significant portion of participants spent less than 25% of their working hours on smartphones (n = 79, 64.2%). However, 52.8% (n = 65) reported experiencing distraction or negative medical consequences due to smartphone use during anesthetized patient care. Despite this, only a small minority felt restrictions on smartphone usage in operating theaters were necessary (n = 36, 29.3%), and most were not irritated by colleagues’ smartphone use (n = 82, 66.7%) [Table 1].
Table 1.
Sociodemographic and other parameters of participants (n=123)
| Question | Answer | Frequency N (%) |
|---|---|---|
| Age | 20-30 Years | 33 (26.8%) |
| 31-40 Years | 34 (27.6%) | |
| 41-50 Years | 30 (24.4%) | |
| 51-60 Years | 17 (13.8%) | |
| >60 Years | 9 (7.3%) | |
| Gender | Female | 21 (17.1%) |
| Male | 102 (82.9%) | |
| Professional Group | Resident | 38 (30.9%) |
| Fellow | 15 (12.2%) | |
| Assistant Consultant | 9 (7.3%) | |
| Associate Consultant | 10 (8.1%) | |
| Consultant | 51 (41.5%) | |
| Working Hours Spent on Smartphone | <25% | 79 (64.2%) |
| 25-50% | 32 (26.0%) | |
| 50-75% | 9 (7.3%) | |
| >75% | 3 (2.4%) | |
| Smartphone Usage Results in Distraction or Negative Medical Consequences During Anesthetized Patient Care | No | 58 (47.2%) |
| Yes | 65 (52.8%) | |
| Restriction for Smartphone Usage in Operating Theaters at Institution | No | 117 (95.1%) |
| Yes | 6 (4.9%) | |
| Smartphone Usage Should be Restricted in Operating Theaters | No | 87 (70.7%) |
| Yes | 36 (29.3%) | |
| Feel Irritable if Colleague Uses Smartphone During Work Hours | No | 82 (66.7%) |
| Yes | 41 (33.3%) |
Figure 1 shows the purposes of smartphone usage during anesthetized patient care among anesthesiologists. The largest portion of smartphone use is for searching medical knowledge, accounting for 28.5% of the total usage. Phone calls represent 25.6% of usage, followed closely by writing, replying, or reading emails at 21.6%. Social media accounts for 21% of smartphone use, while playing games comprises the smallest portion at 3.2%.
Figure 1.
Purposes of smartphone usage during anesthetized patient care (n = 123)
Table 2 shows the practices of anesthesiologists regarding smartphone usage during anesthetized patient care. A significant portion reported using their smartphones during care, with 46.3% (n = 57) doing so “sometimes” and 17.9% (n = 22) “often”. Most participants had never been warned by colleagues or supervisors about smartphone use (n = 113, 91.9%). Smartphone use at critical stages of anesthesia was minimal, and 85.4% (n = 105) reported never using their phones during these times. Furthermore, 69.9% (n = 86) reported never experiencing distractions or negative consequences due to smartphone use. Also, 48.8% (n = 60) had never witnessed a colleague face distraction, while 22.8% (n = 28) had “sometimes” observed such incidents.
Table 2.
Practice of anesthetists regarding mobile phone usage during anesthetized patient care (n=123)
| Question | Answer | Frequency N (%) |
|---|---|---|
| How often do you use your smartphone during anesthetized patient care? | Seldom | 30 (24.4%) |
| Sometimes | 57 (46.3%) | |
| Often | 22 (17.9%) | |
| Very Often | 14 (11.4%) | |
| Have you ever been warned (verbal or written) by your colleagues or supervisor because of smartphone usage during patient care? | Never | 113 (91.9%) |
| Seldom | 8 (6.5%) | |
| Sometimes | 1 (0.8%) | |
| Very Often | 1 (0.8%) | |
| How often do you use your smartphone at critical stages of anesthesia, such as induction and emergence? | Never | 105 (85.4%) |
| Seldom | 10 (8.1%) | |
| Sometimes | 6 (4.9%) | |
| Often | 2 (1.6%) | |
| Have you ever experienced any distractions or negative medical consequences because of smartphone usage during anesthetized patient care? | Never | 86 (69.9%) |
| Seldom | 21 (17.1%) | |
| Sometimes | 14 (11.4%) | |
| Very Often | 2 (1.6%) | |
| Have you ever witnessed one of your colleagues experience any distraction or negative medical consequences because of smartphone usage during anesthetized patient care? | Never | 60 (48.8%) |
| Seldom | 22 (17.9%) | |
| Sometimes | 28 (22.8%) | |
| Often | 8 (6.5%) | |
| Very Often | 5 (4.1%) |
Figure 2 shows the different methods of smartphone usage that result in distraction or negative medical consequences during anesthetized patient care. The most distracting activity reported is playing games, with 73.2% of respondents acknowledging its impact. Social media usage follows, contributing to 55.3% of distractions or negative outcomes. Surfing the Internet is reported by 31.7%, while phone calls account for 26.0%. Writing or reading emails is reported by 20.3% of participants, and 14.6% stated that they did not experience any distractions or negative consequences.
Figure 2.
Smartphone usage methods result in distraction/negative medical consequence during anesthetized patient care (n = 123)
Table 3 shows the attitudes of anesthetists toward smartphone usage in the OR. The majority (n = 101, 82.1%) preferred smartphones as their primary communication tool in the OR, and a significant portion (n = 105, 85.4%) believed that smartphone usage expedites communication. Nearly all participants (n = 114, 92.7%) had anesthesia-related applications on their smartphones. Furthermore, 81.3% (n = 100) felt that smartphone use has improved patient care, while 18.7% (n = 23) believed it has worsened it.
Table 3.
Attitude of anesthetists toward mobile phone usage during anesthetized patient care and its impact of patient care (n=123)
| Question | Answer | Frequency N (%) |
|---|---|---|
| What is your preferred primary communication tool in the OR? | Pager | 20 (16.3%) |
| Smartphone | 101 (82.1%) | |
| Other | 2 (1.6%) | |
| Do you think Smartphone usage Expedites Communication in the OR? | No | 18 (14.6%) |
| Yes | 105 (85.4%) | |
| Is there any Anesthesia-Related Application on your Smartphone? | No | 9 (7.3%) |
| Yes | 114 (92.7%) | |
| How do you feel smartphone use has impacted patient care? | Improved | 100 (81.3%) |
| Worsened | 23 (18.7%) |
Table 4 shows the association between the frequency of smartphone usage and various variables. Age showed a varied distribution, with the 41–50 years group reporting a high frequency of usage (n = 27, 90.0%), but this association was not statistically significant (P = 0.164). Gender did not show a significant difference in usage frequency (P = 0.624), with similar patterns observed in both males and females. Professional group analysis revealed that consultants had the highest frequency of smartphone usage (n = 42, 82.4%), though the association was not significant (P = 0.405). There was a significant association between the presence of restrictions on smartphone usage in operating theaters and the frequency of usage (P = 0.031). Those without restrictions were more likely to use smartphones frequently. However, no significant associations were found regarding whether smartphone use resulted in distractions (P = 0.186), whether restrictions should be imposed (P = 0.574), or whether colleagues’ smartphone usage during work was found irritating (P = 0.373).
Table 4.
Association between frequency of smartphone usage and different features of anesthetists (n=123)
| Question | Answer | Seldom N (%) | Very Often N (%) | Sig. Value |
|---|---|---|---|---|
| Age | 20-30 Years | 10 (30.3%) | 23 (69.7%) | 0.164b |
| 31-40 Years | 11 (32.4%) | 23 (67.6%) | ||
| 41-50 Years | 3 (10.0%) | 27 (90.0%) | ||
| 51-60 Years | 3 (17.6%) | 14 (82.4%) | ||
| >60 Years | 3 (33.3%) | 6 (66.7%) | ||
| Gender | Female | 6 (28.6%) | 15 (71.4%) | 0.624a |
| Male | 24 (23.5%) | 78 (76.5%) | ||
| Professional Group | Resident | 10 (26.3%) | 28 (73.7%) | 0.405b |
| Fellow | 6 (40.0%) | 9 (60.0%) | ||
| Assistant Consultant | 3 (33.3%) | 6 (66.7%) | ||
| Associate Consultant | 2 (20.0%) | 8 (80.0%) | ||
| Consultant | 9 (17.6%) | 42 (82.4%) | ||
| Working Hours % spent on Smartphone | <25% | 27 (34.2%) | 52 (65.8%) | 0.006b |
| 25-50% | 2 (6.3%) | 30 (93.8%) | ||
| 50-75% | 1 (11.1%) | 8 (88.9%) | ||
| >75% | 0 (0.0%) | 3 (100.0%) | ||
| Smartphone Results in Distraction/Negative Medical Consequences during Anesthetized Patient Care? | No | 11 (19.0%) | 47 (81.0%) | 0.186a |
| Yes | 19 (29.2%) | 46 (70.8%) | ||
| Is there any restriction for smartphone usage in operating theaters at your institution? | No | 26 (22.2%) | 91 (77.8%) | 0.031b |
| Yes | 4 (66.7%) | 2 (33.3%) | ||
| Do you think that smartphone usage should be restricted in operating theaters? | No | 20 (23.0%) | 67 (77.0%) | 0.574a |
| Yes | 10 (27.8%) | 26 (72.2%) | ||
| Do you feel irritable if you find your colleague uses a smartphone during work hours? | No | 18 (22.0%) | 64 (78.0%) | 0.373a |
| Yes | 12 (29.3%) | 29 (70.7%) |
aChi-Square Test, bFisher’s Exact Test
Table 5 shows the association between anesthetists’ perceptions of the impact of smartphone usage on patient care and various demographic and professional features. A significant association was found with age, where younger anesthetists (20–30 years) overwhelmingly felt that smartphone use improved patient care (n = 32, 97.0%) compared to older age groups, especially those over 60 years (P = 0.012). Gender did not significantly affect perceptions (P = 0.762). Professional group analysis showed that residents had a higher belief in the positive impact (n = 35, 92.1%) compared to consultants (n = 38, 74.5%), though this association was not statistically significant (P = 0.147). Working hours spent on smartphones showed a significant association (P = 0.038), with those using smartphones less frequently (<25% of working hours) more likely to perceive a positive impact. A strong and significant association was observed between the perception of smartphone usage resulting in distractions or negative consequences and its impact on patient care (P < 0.001), with those not experiencing distractions more likely to report improved patient care (n = 56, 96.6%). Similarly, those who felt smartphone usage should not be restricted were more likely to perceive a positive impact on patient care (P < 0.001). Finally, a significant association was found between irritability at colleagues’ smartphone usage and perceptions of its impact on patient care (P < 0.001), with those not feeling irritated more likely to report improved care (n = 76, 92.7%).
Table 5.
Association between anesthetist’s perception about impact of smartphone usage on patient care and different features (n=123)
| Question | Answer | Impact of Smartphone Use on Patient Care |
Sig. Value | |
|---|---|---|---|---|
| Improved N (%) | Worsened N (%) | |||
| Age | 20-30 Years | 32 (97.0%) | 1 (3.0%) | 0 0.012b |
| 31-40 Years | 28 (82.4%) | 6 (17.6%) | ||
| 41-50 Years | 23 (76.7%) | 7 (23.3%) | ||
| 51-60 Years | 12 (70.6%) | 5 (29.4%) | ||
| >60 Years | 5 (55.6%) | 4 (44.4%) | ||
| Gender | Female | 18 (85.7%) | 3 (14.3%) | 0.762b |
| Male | 82 (80.4%) | 20 (19.6%) | ||
| Professional Group | Resident | 35 (92.1%) | 3 (7.9%) | 0.147b |
| Fellow | 13 (86.7%) | 2 (13.3%) | ||
| Assistant Consultant | 6 (66.7%) | 3 (33.3%) | ||
| Associate Consultant | 8 (80.0%) | 2 (20.0%) | ||
| Consultant | 38 (74.5%) | 13 (25.5%) | ||
| Working Hours % spent on Smartphone | <25% | 69 (87.3%) | 10 (12.7%) | 0.038b |
| 25-50% | 23 (71.9%) | 9 (28.1%) | ||
| 50-75% | 7 (77.8%) | 2 (22.2%) | ||
| >75% | 1 (33.3%) | 2 (66.7%) | ||
| Smartphone Results in Distraction/Negative Medical Consequences during Anesthetized Patient Care? | No | 56 (96.6%) | 2 (3.4%) | <0.001a |
| Yes | 44 (67.7%) | 21 (32.3%) | ||
| Is there any restriction for smartphone usage in operating theaters at your institution? | No | 94 (80.3%) | 23 (19.7%) | 0.593b |
| Yes | 6 (100.0%) | 0 (0.0%) | ||
| Do you think that smartphone usage should be restricted in operating theaters? | No | 80 (92.0%) | 7 (8.0%) | <0.001a |
| Yes | 20 (55.6%) | 16 (44.4%) | ||
| Do you feel irritable if you find your colleague uses a smartphone during work hours? | No | 76 (92.7%) | 6 (7.3%) | <0.001a |
| Yes | 24 (58.5%) | 17 (41.5%) | ||
aChi-Square Test, bFisher’s Exact Test
Discussion
Smartphones are widely used by healthcare providers for educational purposes, communication, and patient monitoring, enhancing care quality and reducing errors.[16,17] However, their use can also cause distractions and impair cognitive functions, particularly for anesthesiologists in ORs. King et al.[18] highlighted that uncontrolled smartphone use in healthcare can cause distractions, poor patient care, and significant behavioral impacts. While concerns about smartphone use in healthcare exist, not many studies have evaluated anesthesiologists’ perspective. Our study examines anesthesiologists’ smartphone habits and attitudes regarding cell phone use in the OR in a tertiary care hospital in Riyadh, Saudi Arabia.
Notably, our study found that 17.9% of anesthesiologists used smartphones during patient care frequently, and 46.3% of anesthesiologists used them sometimes. Similarly, a study by Ambasta et al.[14] shows that 21.8% of anesthesiologists used smartphones very often during anesthetized patient care. The primary purposes of smartphone use were for searching medical knowledge (28.5%), making phone calls (25.6%), and managing emails (21.6%). Mobasheri et al.[20] showed that physicians use smartphones and mobile apps for communication, clinical decision-making, drug compendium, medical education and training, maintaining health records, managing time, and monitoring patients in clinical practice.[19,20] These findings align with previous studies, such as the work by Lee et al.,[19] which highlighted the increasing reliance of healthcare professionals on smartphones for accessing medical information and enhancing clinical decision-making. Similarly, Prgomet et al.[3] reported that mobile technology has a positive impact on hospital physicians’ work practices and patient care by providing quick access to relevant information. However, our study also identified nonmedical use of smartphones, with social media and games accounting for 21% and 3.2% of usage, respectively. This raises concerns as nonmedical smartphone use can lead to significant distractions in critical care environments. Similarly, Attri et al.[6] show that noise created from the ringing of mobile phones may cause distraction, especially while performing laryngoscopy or endotracheal intubation or during crucial steps of surgery.
The dual nature of smartphone use in healthcare settings is further reflected in our findings regarding its impact on patient care. While 69.9% of participants reported never experiencing distractions due to smartphone use, 52.8% acknowledged that such use could lead to distractions or negative medical consequences. This dichotomy is well documented in the literature. For instance, a study by Wilmer et al.[21] found that while smartphones can enhance communication and facilitate quick access to information, they can also serve as sources of distraction, potentially impairing cognitive function and clinical performance.
Interestingly, despite the recognized risks, only 29.3% of our participants felt that restrictions on smartphone use in the OR were necessary. This is consistent with the findings of Thornton et al.,[7] who reported that healthcare professionals often underestimate the distracting potential of smartphones, even when acknowledging their negative effects on attention and task performance.
Our study also explored anesthesiologists’ attitudes toward smartphone use in the OR. A significant majority (82.1%) preferred smartphones as their primary communication tool, and 85.4% believed that smartphones expedite communication, which aligns with the findings of Soto et al.,[5] who noted that mobile phones improve communication efficiency in critical care settings. Moreover, nearly all participants (92.7%) had anesthesia-related applications on their smartphones, highlighting the integration of mobile technology into their professional practice. Green et al.[22] show that mobile apps, dubbed “pocket brains,” enhance anesthesiology by offering tools beyond textbooks, but they should complement, not replace, the expertise of fully trained anesthesiologists in patient care.
However, the perception of the impact of smartphone use on patient care varied significantly with age, with younger anesthesiologists more likely to believe that smartphone use improves patient care. This generational difference may reflect varying levels of comfort and familiarity with mobile technology as younger professionals are typically more adept at integrating digital tools into their workflow. This finding is consistent with the study by Ambasta et al.,[14] which found that younger anesthesiologists were more likely to use smartphones for clinical tasks during work hours.
Moreover, the lack of significant associations between smartphone use frequency and demographic factors such as age and gender, as well as professional group, suggests that smartphone use is widespread across different subsets of anesthesiologists. However, the significant association between the perception of smartphone usage resulting in distractions and its impact on patient care underscores the importance of understanding individual attitudes toward smartphone use in clinical settings.[23]
Our study has several limitations. First, it is confined to a single tertiary care hospital in Riyadh, limiting the generalizability of the findings to other regions or healthcare settings. Second, the reliance on self-reported data through questionnaires may introduce bias as participants might underreport or overestimate their smartphone usage. Additionally, the cross-sectional design of the study only captures a snapshot in time, preventing the assessment of long-term trends or causality.
This study highlights the need for balanced guidelines regarding smartphone use in ORs. While smartphones are essential for communication and accessing medical information, their potential to distract anesthesiologists and impact patient care cannot be ignored. Future research should explore strategies to mitigate distractions, such as developing focused training programs on responsible smartphone use during patient care and implementing technology-based solutions like app restrictions during critical procedures. Additionally, longitudinal studies are needed to assess the long-term effects of smartphone use on clinical outcomes, ensuring that these tools enhance rather than hinder patient safety and care quality.
Conclusion
While smartphones are indispensable tools for anesthesiologists, offering numerous benefits in terms of communication and access to information, their potential to cause distractions and negatively impact patient care cannot be overlooked. Our study highlights the need for balanced policies that maximize the benefits of smartphone use while minimizing its risks. Further research should explore strategies to mitigate the negative consequences of smartphone use in the OR, ensuring that technology enhances rather than hinders patient care.
Ethical approval
This study was approved by King Abdullah International Medical Research Center with approval number IRB/2286 / 23.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
References
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