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
Dr. McGowan has served in leadership positions in numerous medical educational organizations and commercial supporters and is a Fellow of the Alliance (FACEhp). He founded the Outcomes Standardization Project, launched and hosted the Alliance Podcast, and most recently launched and hosts the JCEHP Emerging Best Practices in CPD podcast. In 2012 he Co-Founded ArcheMedX, Inc, a healthcare informatics and e-learning company to apply his research in practice.
