Using an electronic tool to improve teamwork and interprofessional communication to meet the needs of complex hospitalized patients: A mixed methods study

BACKGROUND Teamwork and interprofessional communication are important in addressing the comprehensive care needs of complex hospitalized patients. The objective of this study is to evaluate the impact of an electronic interprofessional communication and collaboration platform on teamwork, communication, and adverse events in the hospital setting. MATERIALS AND METHODS In this mixed methods study, we used a quasi-experimental design in the quantitative component and deployed the electronic tool in a staged fashion to 2 hospital wards 3 months apart. We measured teamwork, communication, and adverse events with Relational Coordination survey, video recordings of team rounds, and retrospective chart review. We conducted qualitative semi-structured interviews with clinicians to understand the perceived impacts of the electronic tool and other contextual factors. RESULTS Teamwork sustainably improved (overall Relational Coordination score improved from 3.68 at baseline to 3.84 at three and six months after intervention, p = 0.03) on ward 1. A small change in face-to-face communication pattern during team rounds was observed (making plans increased from 22% to 24%, p = 0.004) at 3 months on ward 1 but was not sustained at 6 months. Teamwork and communication did not change after the intervention on ward 2. There was no meaningful change to adverse event rates on either ward. Clinicians reported generally positive views about the electronic tool's impact but described non-technology factors on each ward that affected teamwork and communication. CONCLUSION The impact of using an electronic tool to improve teamwork and communication in the hospital setting appears mixed, but can be positive in some settings. Improving teamwork and communication likely require both appropriate technology and addressing non-technology factors.

[1]  E. Etchells,et al.  Implementation and evaluation of an alpha-numeric paging system on a resident inpatient teaching service. , 2009, Journal of hospital medicine.

[2]  S. Y. Liaw,et al.  Collaboration between hospital physicians and nurses: an integrated literature review. , 2013, International nursing review.

[3]  A. O’Cathain,et al.  Three techniques for integrating data in mixed methods studies , 2010, BMJ : British Medical Journal.

[4]  Flory Nkoy,et al.  A Tool for Improving Patient Discharge Process and Hospital Communication Practices: the Patient Tracker , 2007, AMIA.

[5]  Cynthia L. Foronda,et al.  Interprofessional communication in healthcare: An integrative review. , 2016, Nurse education in practice.

[6]  K. O’Leary,et al.  Assessing Interprofessional Teamwork in Inpatient Medical Oncology Units. , 2015, Journal of oncology practice.

[7]  Marianne Tinnå,et al.  IHI Global Trigger Tool for Measuring Adverse Events (Second Edition) , 2015 .

[8]  Walter P. Wodchis,et al.  A scoping review and thematic classification of patient complexity: offering a unifying framework , 2012, Journal of comorbidity.

[9]  Marc Berg,et al.  Patient care information systems and health care work: a sociotechnical approach , 1999, Int. J. Medical Informatics.

[10]  Eduardo Salas,et al.  Communicating, coordinating, and cooperating when lives depend on it: tips for teamwork. , 2008, Joint Commission journal on quality and patient safety.

[11]  Aziz Sheikh,et al.  The case study approach , 2011, BMC medical research methodology.

[12]  P. Carayon,et al.  Work system design for patient safety: the SEIPS model , 2006, Quality and Safety in Health Care.

[13]  T. Greenhalgh,et al.  Realist review - a new method of systematic review designed for complex policy interventions , 2005, Journal of health services research & policy.

[14]  Aziz Sheikh,et al.  Organizational issues in the implementation and adoption of health information technology innovations: An interpretative review , 2013, Int. J. Medical Informatics.

[15]  F. Lau,et al.  It's not about pager replacement: an in-depth look at the interprofessional nature of communication in healthcare. , 2013, Journal of hospital medicine.

[16]  Terence Tang,et al.  Clinician user involvement in the real world: Designing an electronic tool to improve interprofessional communication and collaboration in a hospital setting , 2018, Int. J. Medical Informatics.

[17]  R. Perla,et al.  The run chart: a simple analytical tool for learning from variation in healthcare processes , 2011, Quality and Safety in Health Care.

[18]  Mark V. Williams,et al.  Impact of Localizing Physicians to Hospital Units on Nurse—Physician Communication and Agreement on the Plan of Care , 2009, Journal of General Internal Medicine.

[19]  Robert M Mentzer,et al.  Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions. , 2007, Journal of the American College of Surgeons.

[20]  Scott Reeves,et al.  Disengaged: a qualitative study of communication and collaboration between physicians and other professions on general internal medicine wards , 2013, BMC Health Services Research.

[21]  A. Kempe,et al.  Importance of mixed methods in pragmatic trials and dissemination and implementation research. , 2013, Academic pediatrics.

[22]  Andreas Müller,et al.  Hospital doctors' workflow interruptions and activities: an observation study , 2011, Quality and Safety in Health Care.

[23]  Dante Morra,et al.  A smartphone-enabled communication system to improve hospital communication: usage and perceptions of medical trainees and nurses on general internal medicine wards. , 2015, Journal of hospital medicine.

[24]  J. Cuschieri,et al.  Preventing hospital-acquired venous thromboembolism: Improving patient safety with interdisciplinary teamwork, quality improvement analytics, and data transparency. , 2016, Journal of hospital medicine.

[25]  Lisanne C. Cruz,et al.  Barriers to discharge from inpatient rehabilitation: a teamwork approach. , 2017, International journal of health care quality assurance.

[26]  Robert C. Wu,et al.  Perceptions of urgency: Defining the gap between what physicians and nurses perceive to be an urgent issue , 2013, Int. J. Medical Informatics.

[27]  U. Sarkar,et al.  Efficiency and Interpretability of Text Paging Communication for Medical Inpatients: A Mixed-Methods Analysis , 2017, JAMA internal medicine.

[28]  Timothy P. Johnson,et al.  Response rates and nonresponse errors in surveys. , 2012, JAMA.

[29]  Amanda Holt,et al.  Using the telephone for narrative interviewing: a research note , 2010 .

[30]  S. Kolakowsky-Hayner,et al.  Interdisciplinary communication and collaboration among physicians, nurses, and unlicensed assistive personnel. , 2015, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[31]  Katherine S. Blondon,et al.  Interprofessional Collaboration on an Internal Medicine Ward: Role Perceptions and Expectations among Nurses and Residents , 2013, PloS one.

[32]  Ross E. G. Upshur,et al.  Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study. , 2017, CMAJ open.

[33]  L. Fratiglioni,et al.  Aging with multimorbidity: A systematic review of the literature , 2011, Ageing Research Reviews.

[34]  Jody Hoffer Gittell,et al.  A Relational Model of How High-Performance Work Systems Work , 2010, Organ. Sci..

[35]  Elaine C. Khoong,et al.  Pagers and Beyond in an Era of Microcommunications-What Is Old Is New Again. , 2017, JAMA internal medicine.

[36]  William A Ghali,et al.  Barriers to discharge in an acute care medical teaching unit: a qualitative analysis of health providers’ perceptions , 2015, Journal of multidisciplinary healthcare.

[37]  Michael M. Abecassis,et al.  The use of technology for urgent clinician to clinician communications: A systematic review of the literature , 2015, Int. J. Medical Informatics.

[38]  Anuj K. Dalal,et al.  Changes in medical errors after implementation of a handoff program. , 2014, The New England journal of medicine.

[39]  Dante Morra,et al.  Frequency and clinical importance of pages sent to the wrong physician. , 2009, Archives of internal medicine.

[40]  B. Hemmelgarn,et al.  Exploring physician specialist response rates to web-based surveys , 2015, BMC Medical Research Methodology.

[41]  H. Wong,et al.  Understanding interprofessional communication: a content analysis of email communications between doctors and nurses , 2012, Applied Clinical Informatics.

[42]  Robert C. Wu,et al.  Effects of clinical communication interventions in hospitals: A systematic review of information and communication technology adoptions for improved communication between clinicians , 2012, Int. J. Medical Informatics.

[43]  K. Sutcliffe,et al.  Communication Failures: An Insidious Contributor to Medical Mishaps , 2004, Academic medicine : journal of the Association of American Medical Colleges.

[44]  Joseph Finkelstein,et al.  The use and interpretation of quasi-experimental studies in medical informatics. , 2006, Journal of the American Medical Informatics Association : JAMIA.

[45]  Robert C. Wu,et al.  Short message service or disService: Issues with text messaging in a complex medical environment , 2014, Int. J. Medical Informatics.

[46]  Walter P Wodchis,et al.  The increasing burden and complexity of multimorbidity , 2015, BMC Public Health.

[47]  Marc Berg,et al.  Implementing information systems in health care organizations: myths and challenges , 2001, Int. J. Medical Informatics.

[48]  Ingrid M. Nembhard,et al.  Measuring Teamwork in Health Care Settings: A Review of Survey Instruments , 2014, Medical care.

[49]  Scott Reeves,et al.  Improving Hospital Care and Collaborative Communications for the 21st Century: Key Recommendations for General Internal Medicine , 2012, Interactive journal of medical research.

[50]  William B Lober,et al.  A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours. , 2005, Journal of the American College of Surgeons.

[51]  Marie-Pierre Gagnon,et al.  Impact of Information and Communication Technologies on Nursing Care: Results of an Overview of Systematic Reviews , 2017, Journal of medical Internet research.

[52]  Jody Hoffer Gittell,et al.  Teamwork methods for accountable care: relational coordination and TeamSTEPPS®. , 2015, Health care management review.

[53]  T. Manser,et al.  Do team processes really have an effect on clinical performance? A systematic literature review. , 2013, British journal of anaesthesia.

[54]  Julia Neily,et al.  Root cause analysis of serious adverse events among older patients in the Veterans Health Administration. , 2014, Joint Commission journal on quality and patient safety.

[55]  M. Pringle,et al.  Evaluating eHealth: How to Make Evaluation More Methodologically Robust , 2009, PLoS medicine.

[56]  Sherman Quan.  Signing on to sign-out: creation of a web-based patient sign-out application. , 2005, Healthcare quarterly.

[57]  T. Manser.  Teamwork and patient safety in dynamic domains of healthcare: a review of the literature , 2009, Acta anaesthesiologica Scandinavica.

[58]  Hein Putter,et al.  Pilot study of the development of a theory-based instrument to evaluate the communication process during multidisciplinary team conferences in rheumatology , 2005, Int. J. Medical Informatics.

[59]  D. Baker,et al.  Patterns of nurse–physician communication and agreement on the plan of care , 2010, Quality and Safety in Health Care.

[60]  Anastasia Papazafeiropoulou,et al.  An evaluation framework for Health Information Systems: human, organization and technology-fit factors (HOT-fit) , 2008, Int. J. Medical Informatics.

[61]  Adam H. Greene.  HIPAA compliance for clinician texting. , 2012, Journal of AHIMA.

[62]  N. Britten.  Qualitative Research: Qualitative interviews in medical research , 1995 .

[63]  S. Sheps,et al.  The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada , 2004, Canadian Medical Association Journal.

[64]  W. Dunsmuir,et al.  The impact of interruptions on clinical task completion , 2010, Quality and Safety in Health Care.