Browsing by Author "Wong, Brian M"
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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
- 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
- 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