It's not about pager replacement: An in-depth look at the interprofessional nature of communication in healthcare

Authors

  • Sherman D. Quan MSc,

    Corresponding author
    • Centre for Innovation in Complex Care, University Health Network, Toronto, Canada
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  • Robert C. Wu MD, MSc, FRCPC,

    1. Centre for Innovation in Complex Care, University Health Network, Toronto, Canada
    2. Department of Medicine, University of Toronto, Toronto, Canada
    3. Division of General Internal Medicine, University Health Network, Toronto, Canada
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  • Peter G. Rossos MD, MBA, FRCPC,

    1. Centre for Innovation in Complex Care, University Health Network, Toronto, Canada
    2. Department of Medicine, University of Toronto, Toronto, Canada
    3. Centre for Global eHealth Innovation, University Health Network, Toronto, Canada
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  • Teri Arany,

    1. Centre for Innovation in Complex Care, University Health Network, Toronto, Canada
    2. Division of General Internal Medicine, University Health Network, Toronto, Canada
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  • Silvi Groe,

    1. Centre for Innovation in Complex Care, University Health Network, Toronto, Canada
    2. Division of General Internal Medicine, University Health Network, Toronto, Canada
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  • Dante Morra MD, MBA, FRCPC,

    1. Centre for Innovation in Complex Care, University Health Network, Toronto, Canada
    2. Department of Medicine, University of Toronto, Toronto, Canada
    3. Division of General Internal Medicine, University Health Network, Toronto, Canada
    4. Centre for Interprofessional Education, University of Toronto, Toronto, Canada
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  • Brian M. Wong MD, FRCPC,

    1. Centre for Innovation in Complex Care, University Health Network, Toronto, Canada
    2. Department of Medicine, University of Toronto, Toronto, Canada
    3. Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
    4. Centre for Patient Safety, University of Toronto, Toronto, Canada
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  • Rodrigo Cavalcanti MD, FRCPC,

    1. Centre for Innovation in Complex Care, University Health Network, Toronto, Canada
    2. Department of Medicine, University of Toronto, Toronto, Canada
    3. Division of General Internal Medicine, University Health Network, Toronto, Canada
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  • William Coke MD, FRCPC,

    1. Centre for Innovation in Complex Care, University Health Network, Toronto, Canada
    2. Department of Medicine, University of Toronto, Toronto, Canada
    3. Division of General Internal Medicine, University Health Network, Toronto, Canada
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  • Francis Y. Lau PhD

    1. School of Health Information Science, University of Victoria, Victoria, Canada
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Address for correspondence and reprint requests: Sherman Quan, MSc, Centre for Innovation in Complex Care, University Health Network, 190 Elizabeth St., Room 13N1382, Toronto, ON M5G 2C4 Canada; Telephone: 416-843-1330; E-mail: sherman.quan@uhn.ca

Abstract

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. Journal of Hospital Medicine 2013;8:137–143. © 2013 Society of Hospital Medicine

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