Browsing by Author "Rossos, Peter G"
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- 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
- 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
- ItemA mobile phone based remote patient monitoring system for chronic disease management.(2007-10-03) Trudel, Mathieu; Cafazzo, Joseph A; Hamill, Melinda; Igharas, Walter; Tallevi, Kevin; Picton, Peter; Lam, Jack; Rossos, Peter G; Easty, Anthony C; Logan, AlexanderRising concern over the poor state of chronic disease management led to the user informed design and development of a home tele monitoring system Focus groups with patients and primary care providers guided the research team towards a design that would accommodate the workflow and concerns of the healthcare providers and the low use and comfort with technology found among the patient population The system was trialed in a before and after pilot study of 34 patients with diabetes and hypertension Findings demonstrate a significant improvement in systolic and diastolic blood pressure An RCT beginning in 2007 is being conducted to confirm these findings It is hypothesized that this user centred approach utilizing focus groups iterative design and human factors methods of evaluation will lead to the next generation of home tele monitoring applications that are more intuitive less cumbersome and ultimately bring about greater patient compliance and better physician management
- ItemPerception of eye contact in video teleconsultation.(2007-02-09) Tam, Tony; Cafazzo, Joseph A; Seto, Emily; Salenieks, Mary Ellen; Rossos, Peter GDuring patient consultations by videoconferencing clinicians often sit as close as 1 m from the videoconferencing units creating a significant eye gaze angle i e the angle between the eye and the camera and the eye and the centre of the display Eye gaze angle may adversely affect the satisfaction with videoconferencing Four videoconferencing environments were examined desktop PC portable telehealth unit videoconferencing room and a boardroom equipped with a ceiling mounted camera and a projection screen Two still images of each of the three subjects were captured one at a 7 degrees eye gaze angle and the other at 15 degrees Each of 53 observers ranked four pairs of images for each of the three subjects In 87 of cases the observers perceived better eye contact at an eye gaze angle of 7 degrees than 15 degrees Also 92 of observers responded that the difference in the perceived eye contact was important to them as patients Improved eye contact can be realized by increasing the horizontal distance of participants from the videoconferencing unit
- ItemThe role of law and policy in tele-monitoring.(2006-10-24) Akalu, Rajen; Rossos, Peter G; Chan, Christopher TThis commentary examines the impact and limitations of existing legal policy as it relates to tele monitoring and considers the extent to which it serves to promote or impede remote monitoring technologies in the context of chronic illness
- ItemTelemanagement of hypertension: a qualitative assessment of patient and physician preferences.(2007-05-30) Halifax, Nancy V D; Cafazzo, Joseph A; Irvine, M Jane; Hamill, Melinda; Rizo, Carlos A; McIssac, Warren J; Rossos, Peter G; Logan, Alexander GBACKGROUND Prevalence surveys have consistently found that the blood pressure control rate among people with hypertension is less than 25 Studies of telemedicine as a means of providing care to hypertensive patients have shown that this approach is effective in lowering blood pressure Major design flaws and high operating costs however have hindered its adoption by physicians and patients OBJECTIVES In the present commentary the field of telemedicine as it pertains to hypertension management is reviewed and the investigators experiences in developing a new telemedicine system are outlined METHODS An applied qualitative case study approach was used to determine the information needs for the design of a telemedicine system Opinions were elicited separately from type 2 diabetic patients with hypertension n 24 and family practitioners in active clinical practice n 18 RESULTS Physician and patient focus group meetings provided key information that led to changes in the prototype system The low level of computer and Internet use by patients in everyday life and by physicians in practice related activities precluded their inclusion in the design of the system for information retrieval and receiving clinical alerts For patients the mobile phone appeared to be an acceptable alternative The only practical automated means to disseminate reports and alerts to physicians was by fax which was the most universally available device in a doctor s office CONCLUSION This tightly focused qualitative study led to the development of design principles for a prototype system increasing the likelihood of user acceptance and improving its effectiveness
- 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