Browsing by Author "Quan, Sherman"
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- ItemA cluster randomized trial evaluating electronic prescribing in an ambulatory care setting.(2007-11-23) Zwarenstein, Merrick F; Dainty, Katie N; Quan, Sherman; Kiss, Alex; Adhikari, Neill K JBACKGROUND Medication errors adverse drug events and potential adverse drug events are common and serious in terms of the harms and costs that they impose on the health system and those who use it Errors resulting in preventable adverse drug events have been shown to occur most often at the stages of ordering and administration This paper describes the protocol for a pragmatic trial of electronic prescribing to reduce prescription error The trial was designed to overcome the limitations associated with traditional study design DESIGN This study was designed as a 65 week cluster randomized parallel study METHODS The trial was conducted within ambulatory outpatient clinics in an academic tertiary care centre in Ontario Canada The electronic prescribing software for the study is a Canadian electronic prescribing software package which provides physician prescription entry with decision support at the point of care Using a handheld computer PDA the physician selects medications using an error minimising menu based pick list from a comprehensive drug database create specific prescription instructions and then transmit the prescription directly and electronically to a participating pharmacy via facsimile or to the physician s printer using local area wireless technology The unit of allocation and randomization is by week i e the system is on or off according to the randomization scheme and the unit of analysis is the prescription with adjustment for clustering of patients within practitioners DISCUSSION This paper describes the protocol for a pragmatic cluster randomized trial of point of care electronic prescribing which was specifically designed to overcome the limitations associated with traditional study design TRIAL REGISTRATION This trial has been registered with clinicaltrials gov ID NCT00252395
- 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
- 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
- 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