I like the concept of “thinking outside the box.” This phrase means that one envisions concepts or approaches to a problem in an unconventional or highly original manner. In other words, one’s thinking is not constrained inside a conventional “box.” The term is believed to have originated with management consultants in the 1970s and 1980s when they sought clients who were innovative and original in their thinking. During my tenure as chairman of medicine at the University of Arizona College of Medicine, I cherished faculty members who would come to me with new and original ways of doing things.
One such idea, still a part of our medical curriculum, is a twice annual symposium involving nursing, law, and medical students, in which a clinical case is described containing issues that require input from all three areas of discipline (eg, a potential end-of-life patient whose family members strongly disagree about the appropriate course of action).
The current issue of The American Journal of Medicine contains a report that seems to me to be an example of thinking outside the box. This study1 examined the effect of an intervention for in-patients who were at high risk for delirium. The simple intervention involved the use of mechanical, robotic stuffed cats similar in outward appearance to the traditional plush teddy bear. These stuffed animal cats contained a motor and a computer chip that enabled them to move and to make appropriate cat noises, such as purring. The concept tested was whether giving patients at risk for in-hospital delirium a robotic pet would decrease the likelihood of them developing agitation and confusion during their in-patient stay. Although this was a small pilot study, the results were indeed encouraging. Patients who received the robotic cats were less likely to develop the negative features described during their hospitalization. Interestingly, many patients and families requested that a similar stuffed dog would have been even more effective, given the patient’s history of fondness for dogs.
Why would such an intervention work? Many hospitals including my own have long had programs involving the bringing of special designated “visiting” dogs into the hospital to visit at the patients’ bedsides.2, 3, 4, 5, 6, 7, 8 As a dog and cat lover myself, I am always glad to see these canine visitors when they are walking the wards of our hospital.
Golden retrievers seem to be the breed that most frequently visits the Banner University of Arizona Hospital. Our “caring dogs” are all calm, friendly, and love being petted. I am sure our readers can imagine the joy that these animals bring to in-patients on the pediatric floors. Not surprisingly, adult patients are also glad to receive these furry visitors. On occasion, our hospital also allows patients to have small dogs remain in a patient’s room during their hospitalization as long as someone on the nursing or medical assistant staff is willing to take the animal outside periodically to urinate and defecate. The situations in which I have observed dearly loved dogs staying with their owners in the hospital room is with conscious patients who express serious distress because of separation from their canine companion. My hospital requires all visiting dogs to have a safety interview before their first visit. In addition, each visiting therapy dog must receive a thorough shampoo the day before they come to the hospital. The fear that these canine visitors will bring harmful bacteria into the hospital is apparently unfounded.9, 10, 11
Clearly, this report was a preliminary study; however, the results were of great interest because in my experience, in-patient hospital delirium is a common challenging problem for patients, families, and hospital staff. The usual pharmacological interventions can have serious consequences, for example, aspiration pneumonia. I would hope that many other institutions will examine the usefulness of this inexpensive and harmless intervention.
As always, I enjoy hearing from readers about this commentary; please comment on our blog at amjmed.org.
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-Joseph S. Alpert, MDa,b
This article originally appeared in the July 2019 issue of The American Journal of Medicine.
