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Objective: To characterize current use of communication technologies, including standard text messaging and secure mobile messaging applications, for patient care-related (PCR) communication., Methods: We used a Society of Hospital Medicine database to conduct a national cross-sectional survey of hospital-based clinicians., Results: We analyzed data from 620 survey respondents (adjusted response rate, 11.0%). Pagers were provided by hospitals to 495 (79.8%) of these clinicians, and 304 (49%) of the 620 reported they received PCR messages most commonly by pager. Use of standard text messaging for PCR communication was common, with 300 (52.9%) of 567 clinicians reporting receipt of standard text messages once or more per day. Overall, 21.5% (122/567) of respondents received standard text messages that included individually identifiable information, 41.3% (234/567) received messages that included some identifiable information (eg, patient initials), and 21.0% (119/567) received messages for urgent clinical issues at least once per day. About one-fourth of respondents (26.6%, 146/549) reported their organization had implemented a secure messaging application that some clinicians were using, whereas few (7.3%, 40/549) reported their organization had implemented an application that most clinicians were using., Discussion: Pagers remain the technology most commonly used by hospital-based clinicians, but a majority also use standard text messaging for PCR communication, and relatively few hospitals have fully implemented secure mobile messaging applications., Conclusion: The wide range of technologies used suggests an evolution of methods to support communication among healthcare professionals., (© 2017 Society of Hospital Medicine)

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.

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., (Copyright © 2013 Society of Hospital Medicine.)

Background: 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 < 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., (Copyright © 2010 Society of Hospital Medicine.)

Abstract: Objective: To conduct a systematic review of the literature to identify, describe and assess interventions of information and communication technology on the processes of communication and associated patient outcomes within hospital settings. Materials and methods: Studies published from the years 1996 to 2010 were considered and were selected if they described an evaluation of information and communication technology interventions to improve clinical communication within hospitals. Two authors abstracted data from full text articles, and the quality of individual articles were appraised. Results of interventions were summarized by their effect. Results: There were 18 identified studies that evaluated the use of interventions that included alphanumeric paging, hands-free communication devices, mobile phones, smartphones, task management systems and a display based paging system. Most quantitative studies used a before and after study design and were of lower quality. Of all the studies, there was only one prospective randomized study, but this study used only simulated communication events. Quantitative studies identified improved perceptions of communication and some improvement in communication metrics. Qualitative studies described improvements in efficiency of communication but also issues of loss of control and reliability. Conclusions: Despite the rapid advancement in information and communications technology over the last decade, there is limited evidence suggesting improvements in the ability of health professionals to communicate effectively. Given the critical nature of communication, we advocate further evaluation of information and communication technology designed to improve communication between clinicians. Outcome measures should include measures of patient-oriented outcomes and efficiency for clinicians. [Copyright &y& Elsevier]