Browsing by Author "Morra, Dante"
Now showing 1 - 11 of 11
Results Per Page
Sort Options
- ItemDemonstrating the BlackBerry as a clinical communication tool: a pilot study conducted through the Centre for Innovation in Complex Care.(2008-12-11) Quan, Sherman; Wu, Robert; Morra, Dante; Wong, Brian M; Mraz, Richard; Hamill, Melinda; Abrams, Howard; Rossos, Peter GCanadians are living longer with chronic medical conditions which have led to an increasing complexity and volume of care for hospitalized patients Effective in patient care depends on the effective coordination of care through rapid and efficient communication between various care providers A delay in coordinating this care has downstream effects on other parts of the system ultimately contributing to increased emergency department wait times To address this system wide issue the Centre for Innovation in Complex Care at the University Health Network collaborated with Sunnybrook Health Sciences Centre to pilot the use of BlackBerry devices on the general internal medicine wards to improve clinical communication We describe the implementation process impact on clinical care and lessons learned from this experience We observed that residents quickly adopted this new technology and felt that it improved their workflow efficiency and productivity
- ItemEducational impact of using smartphones for clinical communication on general medicine: more global, less local.(2013-07-16) Wu, Robert C; Tzanetos, Katina; Morra, Dante; Quan, Sherman; Lo, Vivian; Wong, Brian MBACKGROUND Medical trainees increasingly use smartphones in their clinical work Similar to other information technology implementations smartphone use can result in unintended consequences This study aimed to examine the impact of smartphone use for clinical communication on medical trainees educational experiences DESIGN Qualitative research methodology using interview data ethnographic data and analysis of e mail messages ANALYSIS We analyzed the interview transcripts ethnographic data and e mails by applying a conceptual framework consisting of 5 educational domains RESULTS Smartphone use increased connectedness and resulted in a high level of interruptions These 2 factors impacted 3 discrete educational domains supervision teaching and professionalism Smartphone use increased connectedness to supervisors and may improve supervision making it easier for supervisors to take over but can limit autonomy by reducing learner decision making Teaching activities may be easier to coordinate but smartphone use interrupted learners and reduced teaching effectiveness during these sessions Finally there may be professionalism issues in relation to how residents use smartphones during encounters with patients and health professionals and in teaching sessions CONCLUSIONS We summarized the impact of a rapidly emerging information technology smartphones on the educational experience of medical trainees Smartphone use increase connectedness and allow trainees to be more globally available for patient care but creates interruptions that cause trainees to be less present in their local interactions with staff during teaching sessions Educators should be aware of these findings and need to develop curriculum to address the negative impacts of smartphone use in the clinical training environment
- ItemEffect of a postdischarge virtual ward on readmission or death for high-risk patients: a randomized clinical trial.(2014-10-01) Dhalla, Irfan A; O'Brien, Tara; Morra, Dante; Thorpe, Kevin E; Wong, Brian M; Mehta, Rajin; Frost, David W; Abrams, Howard; Ko, Françoise; Van Rooyen, Patrick; Bell, Chaim M; Gruneir, Andrea; Lewis, Geraint H; Daub, Stacey; Anderson, Geoff M; Hawker, Gillian A; Rochon, Paula A; Laupacis, AndreasHospital readmissions are common and costly and no single intervention or bundle of interventions has reliably reduced readmissions Virtual wards which use elements of hospital care in the community have the potential to reduce readmissions but have not yet been rigorously evaluated
- ItemEffects of clinical communication interventions in hospitals: a systematic review of information and communication technology adoptions for improved communication between clinicians.(2012-10-08) Wu, Robert C; Tran, Kim; Lo, Vivian; O'Leary, Kevin J; Morra, Dante; Quan, Sherman D; Perrier, LaureOBJECTIVE To conduct a systematic review of the literature to identify describe and assess interventions of information and communication technology on the processes of communication and associated patient outcomes within hospital settings MATERIALS AND METHODS Studies published from the years 1996 to 2010 were considered and were selected if they described an evaluation of information and communication technology interventions to improve clinical communication within hospitals Two authors abstracted data from full text articles and the quality of individual articles were appraised Results of interventions were summarized by their effect RESULTS There were 18 identified studies that evaluated the use of interventions that included alphanumeric paging hands free communication devices mobile phones smartphones task management systems and a display based paging system Most quantitative studies used a before and after study design and were of lower quality Of all the studies there was only one prospective randomized study but this study used only simulated communication events Quantitative studies identified improved perceptions of communication and some improvement in communication metrics Qualitative studies described improvements in efficiency of communication but also issues of loss of control and reliability CONCLUSIONS Despite the rapid advancement in information and communications technology over the last decade there is limited evidence suggesting improvements in the ability of health professionals to communicate effectively Given the critical nature of communication we advocate further evaluation of information and communication technology designed to improve communication between clinicians Outcome measures should include measures of patient oriented outcomes and efficiency for clinicians
- ItemAn evaluation of the use of smartphones to communicate between clinicians: a mixed-methods study.(2011-08-30) Wu, Robert; Rossos, Peter; Quan, Sherman; Reeves, Scott; Lo, Vivian; Wong, Brian; Cheung, Mark; Morra, DanteBACKGROUND Communication between clinicians is critical to providing quality patient care but is often hampered by limitations of current systems Smartphones such as BlackBerrys may improve communication but studies of these technologies have been limited to date OBJECTIVE Our objectives were to describe how smartphones were adopted for clinical communication within general internal medical wards and determine their impact on team effectiveness and communication METHODS This was a mixed methods study that gathered data from the frequency of smartphone calls and email messages clinicians interviews and ethnographic observations of clinical communication interactions Triangulation of qualitative and quantitative data was undertaken to develop common themes that encompass comprehensive and representative insights across different methods RESULTS Findings from our study indicated that over a 24 hour period nurses sent on average 22 3 emails to the physicians mostly through the team smartphone the designated primary point of contact for a specific medical team Physicians carrying the team smartphone received on average 21 9 emails and 6 4 telephone calls while sending out 6 9 emails and initiating 8 3 telephone calls over the 24 hour period Our analyses identified both positive and negative outcomes associated with the use of smartphones for clinical communication There was a perceived improvement in efficiency over the use of pagers for clinical communication for physicians nurses and allied health professionals In particular residents found that the use of smartphones helped to increase their mobility and multitasking abilities Negative outcomes included frequent interruptions and discordance between what doctors and nurses considered urgent Nurses perceived a worsening of the interprofessional relationships due to overreliance on messaging by text with a resulting decrease in verbal communication Unprofessional behaviors were observed in the use of smartphones by residents CONCLUSIONS Routine adoption of smartphones by residents appeared to improve efficiency over the use of pagers for physicians nurses and allied health professionals This was balanced by negative communication issues of increased interruptions a gap in perceived urgency weakened interprofessional relationships and unprofessional behavior Further communication interventions are required that balance efficiency and interruptions while maintaining or even improving interprofessional relationships and professionalism
- ItemThe intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals.(2013-06-12) Wu, Robert C; Lo, Vivian; Morra, Dante; Wong, Brian M; Sargeant, Robert; Locke, Ken; Cavalcanti, Rodrigo; Quan, Sherman D; Rossos, Peter; Tran, Kim; Cheung, MarkBACKGROUND Effective clinical communication is critical to providing high quality patient care Hospitals have used different types of interventions to improve communication between care teams but there have been few studies of their effectiveness OBJECTIVES To describe the effects of different communication interventions and their problems DESIGN Prospective observational case study using a mixed methods approach of quantitative and qualitative methods SETTING General internal medicine GIM inpatient wards at five tertiary care academic teaching hospitals PARTICIPANTS Clinicians consisting of residents attending physicians nurses and allied health AH staff working on the GIM wards METHODS Ethnographic methods and interviews with clinical staff doctors nurses medical students and AH professionals were conducted over a 16 month period from 2009 to 2010 RESULTS We identified four categories that described the intended and unintended consequences of communication interventions impacts on senders receivers interprofessional collaboration and the use of informal communication processes The use of alphanumeric pagers smartphones and web based communication systems had positive effects for senders and receivers but unintended consequences were seen with all interventions in all four categories CONCLUSIONS Interventions that aimed to improve clinical communications solved some but not all problems and unintended effects were seen with all systems
- ItemIt's not about pager replacement: an in-depth look at the interprofessional nature of communication in healthcare.(2013-03-05) Quan, Sherman D; Wu, Robert C; Rossos, Peter G; Arany, Teri; Groe, Silvi; Morra, Dante; Wong, Brian M; Cavalcanti, Rodrigo; Coke, William; Lau, Francis YBACKGROUND Institutions have tried to replace the use of numeric pagers for clinical communication by implementing health information technology HIT solutions However failing to account for the sociotechnical aspects of HIT or the interplay of technology with existing clinical workflow culture and social interactions may create other unintended consequences OBJECTIVE To evaluate a Web based messaging system that allows asynchronous communication between health providers and identify the unintended consequences associated with implementing such technology DESIGN Intervention a Web based messaging system at the University Health Network to replace numeric paging practices in May 2010 The system facilitated clinical communication on the medical wards for coordinating patient care Study design pre post mixed methods utilizing both quantitative and qualitative measures PARTICIPANTS Five residents 8 nurses 2 pharmacists and 2 social workers were interviewed Pre post interruption 15 residents from 5 clinical teams in both periods MEASUREMENTS The study compared the type of messages sent to physicians before and after implementation of the Web based messaging system a constant comparative analysis of semistructured interviews was used to generate key themes related to unintended consequences RESULTS Interruptions increased 233 from 3 pages received per resident per day pre implementation to 10 messages received per resident per day post implementation Key themes relating to unintended consequences that emerged from the interviews included increase in interruptions accountability and tactics to improve personal productivity CONCLUSIONS Meaningful improvements in clinical communication can occur but require more than just replacing pagers Introducing HIT without addressing the sociotechnical aspects of HIT that underlie clinical communication can lead to unintended consequences
- ItemMedical students and personal smartphones in the clinical environment: the impact on confidentiality of personal health information and professionalism.(2014-05-23) Tran, Kim; Morra, Dante; Lo, Vivian; Quan, Sherman D; Abrams, Howard; Wu, Robert CSmartphones are becoming ubiquitous in health care settings The increased adoption of mobile technology such as smartphones may be attributed to their use as a point of care information source and to perceived improvements in clinical communication and efficiency However little is known about medical students use of personal smartphones for clinical work
- ItemShort message service or disService: issues with text messaging in a complex medical environment.(2014-03-03) Wu, Robert; Appel, Lora; Morra, Dante; Lo, Vivian; Kitto, Simon; Quan, ShermanHospitals today are experiencing major changes in their clinical communication workflows as conventional numeric paging and face to face verbal conversations are being replaced by computer mediated communication systems In this paper we highlight the importance of understanding this transition and discuss some of the impacts that may emerge when verbal clinical conversations are replaced by short text messages
- ItemThe use of smartphones for clinical communication on internal medicine wards.(2010-12-16) Wu, Robert C; Morra, Dante; Quan, Sherman; Lai, Sannie; Zanjani, Samira; Abrams, Howard; Rossos, Peter GBACKGROUND Communication between clinicians is hampered by the frequent difficulty in reaching the most responsible physician for a patient as well as the use of outdated methods such as numeric paging The aim of this study was to evaluate the use of smartphones to improve communication on internal medicine wards METHOD At the Toronto General Hospital residents were provided with smartphones To simplify reaching the most responsible resident for a patient a smartphone designated as Team BlackBerry was also carried by each senior resident and then passed to the resident covering the team at night and on weekends Nurses were able to send email messages or call smartphones directly RESULTS There were on average of 9 1 incoming calls 6 6 outgoing calls 14 3 received emails and 2 8 sent emails per day to each Team BlackBerry Team BlackBerrys received up to 35 calls and 57 emails per day Residents strongly preferred the smartphones over conventional paging with perceived improvements in all items measured and felt that it improved efficiency and communication Although nurses perceived a reduction in the time required to contact a physician 27 6 vs 11 minutes P Under 0 001 their overall satisfaction with physician s response time for urgent issues did not improve significantly DISCUSSION When smartphones were used for clinical communication residents perceived an improvement in communication with them Residents strongly preferred emails as opposed to telephone calls as the prime method of communication Further objective evaluation is necessary to determine if this intervention improves efficiency and more importantly quality of care
- ItemThe use of smartphones in general and internal medicine units: a boon or a bane to the promotion of interprofessional collaboration?(2012-06-08) Lo, Vivian; Wu, Robert C; Morra, Dante; Lee, Lydia; Reeves, ScottEffective communication and coordination are critical components for improving collaborative care delivery among different healthcare providers who work in mobile and time pressured environments Increasingly healthcare providers are exploring alternative communication technologies to help bridge the temporal and spatial issues that are often inherent in the clinical communication conundrum Our study examined perceptions of General Internal Medicine GIM staff on the usage of Smartphone devices and a Webpaging system which were implemented on the inpatient GIM units at two teaching hospitals in North America An exploratory case study approach was employed and in depth interviews with 31 clinicians were conducted This data set serves as a subset and prelude to a larger research study that examined and compared the impacts of different types of communication technologies used in five teaching hospitals Findings from our study indicate that the use of Smartphone technology was well received among clinicians Specifically healthcare professionals valued the use of emails when communicating nonurgent issues and the availability of the phone function that enabled access to clinicians especially in urgent situations Dissatisfaction however was expressed over the suitability of these smartphone features in different communication contexts as well as discrepancies between clinicians over the appropriate use of the communication modes Future interventions in communication technology should take into considerations how communication mediums and situational contexts e g urgent and nonurgent patient issues impact interprofessional interactions