ABSTRACT: The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals — Wu et al. — Journal of the American Medical Informatics Association
Abstract
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.
Written by Brian S McGowan, PhD
Brian is a research scientist and educational technologist. He helped transform Pfizer’s Medical Education Group and previously served in educational leadership roles at HealthAnswers, Inc.; Acumentis, LLC.; Cephalon; and Wyeth. He taught graduate medical education programs at Arcadia University for 10 years. Dr. McGowan recently authored the book "#socialQI: Simple Solutions for Improving Your Healthcare" and has been invited to speak internationally on the subject of information flow, technology, and learning in healthcare.
