The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals.
J Am Med Inform Assoc. 2013 Jul-Aug;20(4):766-77
Authors: Wu RC, Lo V, Morra D, Wong BM, Sargeant R, Locke K, Cavalcanti R, Quan SD, Rossos P, Tran K, Cheung M
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.
PMID: 23355461 [PubMed - indexed for MEDLINE]