Robert Wu1,2, MD FRCPC MSc; Peter Rossos3, MD FRCPC MBA;
Sherman Quan2, BSC; Scott Reeves4,5,6,7, PhD; Vivian Lo2,
MASc; Brian Wong8, MD FRCPC; Mark Cheung8, MD FRCPC;
Dante Morra1,2,9, MD FRCPC MBA
1University Health Network, Division of General Internal Medicine,
Toronto, ON, Canada
2Centre for Innovation in Complex Care, University Health Network,
Toronto, ON, Canada
3University Health Network, Department of Medicine, Toronto, ON,
Canada
4Centre for Faculty Development, Li Ka Shing International Health
Care Education Centre, St Michael\'s Hospital, Toronto, ON, Canada
5Keenan Research Centre, Li Ka Shing Knowledge Institute of St
Michael’s Hospital, Toronto, ON, Canada
6Wilson Centre for Research in Education, University Health
Network, Toronto, ON, Canada
7Department of Psychiatry, University of Toronto, Toronto, ON,
Canada
8Sunnybrook Health Sciences Centre, Department of Medicine,
Toronto, ON, Canada
9Centre for Interprofessional Education, University of Toronto,
Toronto, ON, Canada
Corresponding Author:
Robert Wu, MD FRCPC MSc
University Health Network
Division of General Internal Medicine
200 Elizabeth Street 14EN-222
Toronto, ON, M5G 2C4
Canada
Phone: 1 416 340 4567
Fax: 1 416 595 5826
Email: robert.wu [at] uhn.on.ca
ABSTRACT
Background: Communication between clinicians is critical to providing
quality patient care but is often hampered by limitations of current systems.
Smartphones such as BlackBerrys may improve communication, but studies
of these technologies have been limited to date.
Objective: Our objectives were to describe how smartphones were adopted
for clinical communication within general internal medical wards and
determine their impact on team effectiveness and communication.
Methods: This was a mixed-methods study that gathered data from the
frequency of smartphone calls and email messages, clinicians\' interviews,
and ethnographic observations of clinical communication interactions.
Triangulation of qualitative and quantitative data was undertaken to develop
common themes that encompass comprehensive and representative
insights across different methods.
Results: Findings from our study indicated that over a 24-hour period,
nurses sent on average 22.3 emails to the physicians mostly through the
“team smartphone,” the designated primary point of contact for a specific
medical team. Physicians carrying the team smartphone received on
average 21.9 emails and 6.4 telephone calls while sending out 6.9 emails
and initiating 8.3 telephone calls over the 24-hour period. Our analyses
identified both positive and negative outcomes associated with the use
of smartphones for clinical communication. There was a perceived
improvement in efficiency over the use of pagers for clinical communication
for physicians, nurses, and allied health professionals. In particular,
residents found that the use of smartphones helped to increase their
mobility and multitasking abilities. Negative outcomes included frequent
interruptions and discordance between what doctors and nurses
considered urgent. Nurses perceived a worsening of the interprofessional
relationships due to overreliance on messaging by text with a resulting
decrease in verbal communication. Unprofessional behaviors were
observed in the use of smartphones by residents.
Conclusions: Routine adoption of smartphones by residents appeared to
improve efficiency over the use of pagers for physicians, nurses, and allied
health professionals. This was balanced by negative communication
issues of increased interruptions, a gap in perceived urgency, weakened
interprofessional relationships, and unprofessional behavior. Further
communication interventions are required that balance efficiency and
interruptions while maintaining or even improving interprofessional
relationships and professionalism.
(J Med Internet Res 2011;13(3):e59)
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