It's not about pager replacement: an in-depth look at the interprofessional nature of communication in healthcare.
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Date
2013-03-05
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Abstract
BACKGROUND 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