As a non-interventional radiologist, I rarely get to the OR. (I do sometimes wander by the ER to discuss some weird finding. This has morphed into the positive Dalai sign; the docs know something bad is afoot if I've made the effort to travel over to their neck of the woods.)
Yesterday, the rad tech working surgery came running down the hall. "How do I get in touch with your IT guys?" he yelled. It seems that one of the surgeons needed to look at images on my group's PACS (not the hospital system) and couldn't get the client running on the hospital computer in the OR. I bravely volunteered to go to the OR myself, and after throwing on some scrubs (and hoping the nasty surgeons wouldn't raid the unlocked locker containing my valuables) I sauntered into the OR like a real surgeon. There, on the table, was the patient with his internal anatomy revealed, and a very frustrated surgeon nearby. I went immediately to the computer in question, and indeed, our AMICAS client wouldn't load, because the bloody computer was locked down, and it wouldn't accept the necessary JAVA run-time code. I quickly called our HELP desk and explained the problem, noting that Dr. X had a patient filleted open on the table, thus requiring assistance NOW. The fellow on the other end apologized, noting that he couldn't do anything, but would contact the DESKTOP help area immediately. In the meantime, I decided to try our program on the computer that was used for patient monitoring and data collection (yes, somewhat risky, but...) and lo and behold, I was able to bring up our client! The surgeon was happy, and I left the OR still not having heard from DESKTOP.
The moral of the story: PACS involves patient care. If a department, be it Radiology or IT, is given the mandate to control and maintain PACS, it has to realize that this is a mission-critical, literally life-and-death proposition. Sometimes, we just don't have five or ten minutes to wait. Yes, I understand that this was an aberrant situation, and I suppose we should be forever grateful that we are allowed to view our "foreign" system from within the hospital at all. Still, this is the way it is, and we need help, not hindrance in these situations. Remember, we're all here to promote patient care. That's the bottom line.
I've received two interesting comments on this post. Anonymous (1) said:
"technically arent you messing with the warrenty on the monitoring system by runing external software on a "closed system"?and Anonymous (2) said...
Sure you might be lucky and everything works nicely with the java runtime and everything, but you might have affected the system in a manner where other patients life are put at risk?
I am certain this isnt adviceable behavior and that it can indanger patients and/or deaths."
"Moral of the story:I think Anonymous (2) is right on. Definately, scalpel should not have touched skin before the images were on-screen. YOU tell that to the surgeon.
Before anything else, preparation is the key to success AGB
In the days of film key images would have been displayed on the light box BEFORE the start of the operation.
If the PACS workstation stopped working without warning, good on you Dr Dalai, I would have been tempted to get a lap-top or pinch a workstation from next door though."
As for Anonymous (1). . . He/she embodies the IT mentality that drives me up the wall. Yes, I was taking a risk, although I believe it was minor. The computer I ultimately got running was actually the data-collection station (drugs, toys used, etc.), and not a true patient monitor. It fortunately already had the proper Java in place. No damage done there.
The patient who is cut open on the table HAS to be one's primary concern in this instance. PERIOD. It seems there are some IT types who would have told the surgeon, "too bad, chump" and walked away because we might have done something to their precious computers. If you are going to deal in health care issues, friends, you need to realize that someone might die if the computer doesn't do what it's supposed to do. Yes, one can hide behind the mantra that altering the computer might harm the next patient. In situations like this, you have to realize that NOT altering the computer had an immediate risk of harm to the patient that was there bleeding (a little) on the table right then. Somehow, IT has to be made to understand the criticality of PACS and patient care.
I'm trying to educate them, slowly but surely.