The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals.

BACKGROUND 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