About the Project

Effective communication between clinicians, particularly during handovers, is critical for patient safety. To address this important aspect of health care, a multi-site observational study was conducted which focused on analyzing communication and clinician interaction with information technology (IT) around the critical process of patient transfer from the emergency department to general internal medicine. The study was sponsored by Healthcare Support through Information Technology Enhancements (hSITE), a research network with a mandate of developing key components of an information technology (IT) infrastructure in the clinical environment.

Main findings included the following:

  • Clinicians complain about the high number of specialized communication tools and software programs. For instance, physicians often have to carry a numeric pager, a mobile phone, and often another pager and their personal phone, and access patient information in the electronic health record, in the paper chart, and in a specialized “sign-out” tool with patient summaries updated daily by physicians.
  • There is a general lack of awareness of patient status (i.e. location, pending tests and consults, etc). Systems designed to mitigate this issue, such as electronic whiteboards, have limited success, due to the need for manual updates and their unintuitive user interfaces.
  • The lines of communication between clinicians are often poor, particularly between mobile, transient physicians and stationary nurses.
  • Despite their many documented drawbacks, numeric pagers continue to be widely used. Additional messaging systems have been introduced, but they usually fail to properly take into account user needs, as both sending a message and replying to it involve a complex workflow.
  • Interruptions and distractions are frequent, as clinicians prefer direct communication to other available options.

Potential consequences of these issues are workflow disruptions, delays in patient care, and inadequate access to time-sensitive patient information, which negatively impact patient safety.

The main communication issues were identified

The need for patient information on a mobile device was evaluated

Patient information access requirements during handover were identified

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Impact

The study results will inform a user-centered design process, and the development of an intervention. It is recommended that this intervention conform to the following seven basic principles: