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Huddled together in the waiting room, the family of a 50-year-old patient anxiously awaits a status update regarding the progress of his brain surgery.

It's a typical hospital scene. But the news regarding the patient's condition won't come directly from the circulating nurse or the surgeon performing the procedure, as is traditional. There will be no tense moments as family members attempt to read the mind of the healthcare professional who's tasked with trying to put the best words together regarding their loved one's condition.

Instead, everyone will get the news over the Internet, through a laptop computer that they've gathered around and have logged into a popular social networking site that's giving frequent reports as to the details of the operation.

Twitter, in particular, is leaving its stamp on the healthcare arena much like it is in the rest of society.

And just as A-list celebrities like Britney Spears and Ashton Kutcher are drawing legions of devoted "followers" for their personal Twitter accounts, so too are facilities such as Henry Ford Hospital in Detroit and Children's Mercy Hospital, Kansas City, MO, where healthcare providers have promoted their use of Twitter during surgeries as a way to not just disseminate information more quickly but also to educate. 

But clinical and legal experts are not so sure the benefits justify the means.

"I doubt there are many risk managers or legal counsel who would tell you this is a wise idea," said Mardy Chizek, MBA, BSN, RN, FNP, AAS, president of Chizek Consulting, Westmont, IL. "From my perspective, I don't see any reason to even debate it. I think it's out of context and not consistent with standard of care."

Ethical vs. Educational

Chizek said her stance on the matter is twofold: she sees dividing one's attention among a patient and a Web page as clinically unsafe, and said the idea overall is ethically unsound.

"Standard of care requires you to stay by the bedside and treat your patient," she told ADVANCE. "I know I wouldn't expect to see my nurse or doctor standing by the bedside texting. That's not appropriate. NFL players have been fined for Tweeting during games, and I think we're probably at a higher standard as healthcare professionals than football players."

Not so fast, say those providers who have experience sending Tweets from the bedside and who contend that the ability to educate and quell the anxiety of patients' loved ones justifies their use of social networking.

"In the last 10 years there's obviously been an explosion of social media and networking sites and technology that's used in every facet of life," said Steven Kalkanis, MD, director of neurosurgical oncology and the cell-based therapeutics laboratory for translational brain tumor research at Henry Ford Hospital. "So this is a way to match what the next generation of students is most comfortable with in terms of learning."

One who's participated in three surgeries in which reports were given via Twitter, Kalkanis said the use of the site has invited interesting questions from hospital followers during live surgeries and helped put things into perspective for family members as they waited out the same surgeries.

"It really has turned into a pretty powerful learning tool for students and families," he said.

Continuity of Care

Most notably, Kalkanis and another surgeon at Henry Ford participated in an awake craniotomy to remove a brain tumor.

The surgery took 4 hours to complete and was presented live on YouTube in addition to the Twitter report. Kalkanis said he and his fellow surgeon typed at least 200 Tweets to the approximately 2,700 followers, which included staff, students, family and, potentially, members of the general public linked into Henry Ford's account.

"We sent updates every minute or 2," said Kalkanis, whose specific role during the procedure was separating the tumor attachments from the normal brain tissue.

Although Kalkanis assured he was never Tweeting while he was performing his specific duties (the surgeons took turns while not engaged with the patient), Chizek said she has specific concerns regarding any healthcare professional who would be conducting surgery and sending updates online.

"I think there's a lapse in continuity of care, assessment and interpretation while you're Tweeting," she said.

Kalkanis disagrees.

"The surgeon who is operating is only focusing on the patient - there is no time taken away from providers at the bedside," he said. "The person doing the Twittering would otherwise be observing or taking notes, not participating in patient care."