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Blom L. mHealth for image-based diagnostics of acute burns in resource-poor settings: studies on the role of experts and the accuracy of their assessments. Glob Health Action 2021; 13:1802951. [PMID: 32814518 PMCID: PMC7480586 DOI: 10.1080/16549716.2020.1802951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Diagnostic assistance using mobile technology is instrumental to timely and adequate care in resource-scarce settings, particularly for acute burns. Little is known, however, as regards to how remote diagnostic consultation in burns affects the work process. This article reviews a doctoral thesis on this topic based on four studies conducted in the Western Cape, South Africa prior to and in a very early phase of the implementation of an app for burn remote diagnostic assistance. The aim was to increase knowledge on how remote diagnostic assistance for burn injuries can influence the role and work of medical experts in a resource-poor setting. The congruence model was used as a reference framework to study the ‘input’ (study 1), ‘tasks’ (studies 2 and 3) and ‘people’ (study 4) involved. The results show higher burn incidence in young children (75.4 per 10 000) and gender differences primarily among adults. The quality of images was considered by experts as better when viewed on smartphones and tablets than on computers. The accuracy of burn size assessments was high overall but low for burn depth (ICC = 0.82 and 0.53 respectively). Experts described four positions pertaining to remote consultations: clinical specialist, gatekeeper, mentor and educator. They perceived images as improving accuracy of consultation and stressed the need for verbal communication among clinicians during critical situations. In conclusion, experts are satisfied with the quality of images seen on handheld devices and can accurately assess burn size using these, yet burn depth assessment is more challenging without additional clinical information. mHealth for diagnostic assistance can benefit current image-based consultation by systematising information quality, introducing enhanced security and improved access to experts. Remaining challenges include the necessity of verbal communication in some instances and replacing existing informal organisational practices.
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Affiliation(s)
- Lisa Blom
- Department of Global Public Health, Karolinska Institutet , Stockholm, Sweden
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2
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Maassen O, Fritsch S, Gantner J, Deffge S, Kunze J, Marx G, Bickenbach J. Future Mobile Device Usage, Requirements, and Expectations of Physicians in German University Hospitals: Web-Based Survey. J Med Internet Res 2020; 22:e23955. [PMID: 33346735 PMCID: PMC7781804 DOI: 10.2196/23955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/06/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023] Open
Abstract
Background The use of mobile devices in hospital care constantly increases. However, smartphones and tablets have not yet widely become official working equipment in medical care. Meanwhile, the parallel use of private and official devices in hospitals is common. Medical staff use smartphones and tablets in a growing number of ways. This mixture of devices and how they can be used is a challenge to persons in charge of defining strategies and rules for the usage of mobile devices in hospital care. Objective Therefore, we aimed to examine the status quo of physicians’ mobile device usage and concrete requirements and their future expectations of how mobile devices can be used. Methods We performed a web-based survey among physicians in 8 German university hospitals from June to October 2019. The online survey was forwarded by hospital management personnel to physicians from all departments involved in patient care at the local sites. Results A total of 303 physicians from almost all medical fields and work experience levels completed the web-based survey. The majority regarded a tablet (211/303, 69.6%) and a smartphone (177/303, 58.4%) as the ideal devices for their operational area. In practice, physicians are still predominantly using desktop computers during their worktime (mean percentage of worktime spent on a desktop computer: 56.8%; smartphone: 12.8%; tablet: 3.6%). Today, physicians use mobile devices for basic tasks such as oral (171/303, 56.4%) and written (118/303, 38.9%) communication and to look up dosages, diagnoses, and guidelines (194/303, 64.0%). Respondents are also willing to use mobile devices for more advanced applications such as an early warning system (224/303, 73.9%) and mobile electronic health records (211/303, 69.6%). We found a significant association between the technical affinity and the preference of device in medical care (χs2=53.84, P<.001) showing that with increasing self-reported technical affinity, the preference for smartphones and tablets increases compared to desktop computers. Conclusions Physicians in German university hospitals have a high technical affinity and positive attitude toward the widespread implementation of mobile devices in clinical care. They are willing to use official mobile devices in clinical practice for basic and advanced mobile health uses. Thus, the reason for the low usage is not a lack of willingness of the potential users. Challenges that hinder the wider adoption of mobile devices might be regulatory, financial and organizational issues, and missing interoperability standards of clinical information systems, but also a shortage of areas of application in which workflows are adapted for (small) mobile devices.
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Affiliation(s)
- Oliver Maassen
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany.,SMITH Consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Sebastian Fritsch
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany.,SMITH Consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Julia Gantner
- SMITH Consortium of the German Medical Informatics Initiative, Leipzig, Germany.,Institute of Medical Statistics, Informatics and Data Science, Jena University Hospital, Jena, Germany
| | - Saskia Deffge
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany.,SMITH Consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Julian Kunze
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany.,SMITH Consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany.,SMITH Consortium of the German Medical Informatics Initiative, Leipzig, Germany
| | - Johannes Bickenbach
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany.,SMITH Consortium of the German Medical Informatics Initiative, Leipzig, Germany
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Martin G, Khajuria A, Arora S, King D, Ashrafian H, Darzi A. The impact of mobile technology on teamwork and communication in hospitals: a systematic review. J Am Med Inform Assoc 2020; 26:339-355. [PMID: 30689893 DOI: 10.1093/jamia/ocy175] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/10/2018] [Accepted: 11/29/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Effective communication is critical to the safe delivery of care but is characterized by outdated technologies. Mobile technology has the potential to transform communication and teamwork but the evidence is currently uncertain. The objective of this systematic review was to summarize the quality and breadth of evidence for the impact of mobile technologies on communication and teamwork in hospitals. MATERIALS AND METHODS Electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL Plus, HMIC, Cochrane Library, and National Institute of Health Research Health Technology Assessment) were searched for English language publications reporting communication- or teamwork-related outcomes from mobile technologies in the hospital setting between 2007 and 2017. RESULTS We identified 38 publications originating from 30 studies. Only 11% were of high quality and none met best practice guidelines for mobile-technology-based trials. The studies reported a heterogenous range of quantitative, qualitative, and mixed-methods outcomes. There is a lack of high-quality evidence, but nonetheless mobile technology can lead to improvements in workflow, strengthen the quality and efficiency of communication, and enhance accessibility and interteam relationships. DISCUSSION This review describes the potential benefits that mobile technology can deliver and that mobile technology is ubiquitous among healthcare professionals. Crucially, it highlights the paucity of high-quality evidence for its effectiveness and identifies common barriers to widespread uptake. Limitations include the limited number of participants and a wide variability in methods and reported outcomes. CONCLUSION Evidence suggests that mobile technology has the potential to significantly improve communication and teamwork in hospital provided key organizational, technological, and security challenges are tackled and better evidence delivered.
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Affiliation(s)
- Guy Martin
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Ankur Khajuria
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Sonal Arora
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Dominic King
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom.,DeepMind, London, United Kingdom
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Tang T, Heidebrecht C, Coburn A, Mansfield E, Roberto E, Lucez E, Lim ME, Reid R, Quan SD. Using an electronic tool to improve teamwork and interprofessional communication to meet the needs of complex hospitalized patients: A mixed methods study. Int J Med Inform 2019; 127:35-42. [PMID: 31128830 DOI: 10.1016/j.ijmedinf.2019.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/29/2019] [Accepted: 04/12/2019] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Terence Tang
- Institute for Better Health and Program of Medicine, Trillium Health Partners, 100 Queensway West, Clinical Administrative Building, 6th floor, Mississauga, Ontario, L5B 1B8, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | | | - Andrea Coburn
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Elizabeth Mansfield
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Canada
| | - Ellen Roberto
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Emanuel Lucez
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Morgan E Lim
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Robert Reid
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Sherman D Quan
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
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DeWane M, Waldman R, Waldman S. Cell phone etiquette in the clinical arena: A professionalism imperative for healthcare. Curr Probl Pediatr Adolesc Health Care 2019; 49:79-83. [PMID: 30981458 DOI: 10.1016/j.cppeds.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cell phones have become a routine part of daily life in the United States; 97.1% of faculty, residents, and medical students carry their personal cell phone with them at work. Concerns about professionalism and potentially inappropriate use of mobile technology have emerged, and challenges to professionalism that are associated with the use of mobile devices in the clinical setting are evolving as technology advances. These issues should be directly addressed by the medical profession. Concerns include questions of privacy/confidentiality, microbial transmission from contact with mobile devices, maintenance of personal/professional boundaries when physicians and patients use mobile devices to communicate, appropriate communication among colleagues, and prioritization of patient care over personal matters.
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Affiliation(s)
- Madeline DeWane
- Department of Dermatology, University of Connecticut School of Medicine, USA
| | - Reid Waldman
- Department of Dermatology, University of Connecticut School of Medicine, USA.
| | - Steven Waldman
- Department of Medical Humanities and Bioethics, University of Missouri-Kansas City School of Medicine, USA
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Assessment of Health Information Technology Interventions in Evidence-Based Medicine: A Systematic Review by Adopting a Methodological Evaluation Framework. Healthcare (Basel) 2018; 6:healthcare6030109. [PMID: 30200307 PMCID: PMC6165327 DOI: 10.3390/healthcare6030109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/15/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The application of Health Information Technologies (HITs) can be an effective way to advance medical research and health services provision. The two-fold objective of this work is to: (i) identify and review state-of-the-art HITs that facilitate the aims of evidence-based medicine and (ii) propose a methodology for HIT assessment. METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Furthermore, we consolidated existing knowledge in the field and proposed a Synthesis Framework for the Assessment of Health Information Technology (SF/HIT) in order to evaluate the joint use of Randomized Controlled Trials (RCTs) along with HITs in the field of evidence-based medicine. RESULTS 55 articles met the inclusion criteria and refer to 51 (RCTs) published between 2008 and 2016. Significant improvements in healthcare through the use of HITs were observed in the findings of 31 out of 51 trials-60.8%. We also confirmed that RCTs are valuable tools for assessing the effectiveness, acceptability, safety, privacy, appropriateness, satisfaction, performance, usefulness and adherence. CONCLUSIONS To improve health service delivery, RCTs apply and exhibit formalization by providing measurable outputs. Towards this direction, we propose the SF/HIT as a framework which may help researchers to carry out appropriate evaluations and extend their studies.
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Christopoulou SC, Kotsilieris T, Anagnostopoulos I. Evidence-based health and clinical informatics: a systematic review on randomized controlled trials. HEALTH AND TECHNOLOGY 2018. [DOI: 10.1007/s12553-016-0170-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Kuziemsky CE, Randell R, Borycki EM. Understanding Unintended Consequences and Health Information Technology:. Contribution from the IMIA Organizational and Social Issues Working Group. Yearb Med Inform 2016:53-60. [PMID: 27830231 DOI: 10.15265/iy-2016-027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE No framework exists to identify and study unintended consequences (UICs) with a focus on organizational and social issues (OSIs). To address this shortcoming, we conducted a literature review to develop a framework for considering UICs and health information technology (HIT) from the perspective of OSIs. METHODS A literature review was conducted for the period 2000- 2015 using the search terms "unintended consequences" and "health information technology". 67 papers were screened, of which 18 met inclusion criteria. Data extraction was focused on the types of technologies studied, types of UICs identified, and methods of data collection and analysis used. A thematic analysis was used to identify themes related to UICs. RESULTS We identified two overarching themes. One was the definition and terminology of how people classify and discuss UICs. Second was OSIs and UICs. For the OSI theme, we also identified four sub-themes: process change and evolution, individual-collaborative interchange, context of use, and approaches to model, study, and understand UICs. CONCLUSIONS While there is a wide body of research on UICs, there is a lack of overall consensus on how they should be classified and reported, limiting our ability to understand the implications of UICs and how to manage them. More mixed-methods research and better proactive identification of UICs remain priorities. Our findings and framework of OSI considerations for studying UICs and HIT extend existing work on HIT and UICs by focusing on organizational and social issues.
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Affiliation(s)
- C E Kuziemsky
- Craig Kuziemsky, Telfer School of Management, University of Ottawa, Ottawa, ON, Canada, Tel: +1 613 562 5800 ext 4792, E-mail:
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Hallet J, Wallace D, El-Sedfy A, Ahmed N, Smith AJ, Nathens AB, Conn LG, Coburn NG. Defining Communication Improvement Needs in General Surgery: An Analysis of Pages, Communications, Patterns, and Content☆?>. JOURNAL OF SURGICAL EDUCATION 2016; 73:959-967. [PMID: 27886968 DOI: 10.1016/j.jsurg.2016.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To describe patterns of pages communication to general surgery (GS) residents, identify the need for and develop strategies to improve interprofessional communication. DESIGN Retrospective cohort study. SETTING General surgery (GS) service at a tertiary care academic institution, Sunnybrook Health Sciences Centre, in Toronto, Ontario, Canada. PARTICIPANTS All pages sent to GS residents over 4 weeks at an academic institution. Timing, training level of receiver and content of pages were captured. RESULTS Communication priority was assigned by 2 independent reviewers-low (121+ min), medium (31-120min), high (6-30min), and immediate (0-5min) priority. Overall, 2 independent reviewers analyzed pages' content through an inductive process, and generated themes. Of 2025 pages retrieved, 963 (47.5%) contained exclusively a call back number. A median of 74 pages per day (range: 43-116) were received, with median page interval of 9.4 minutes (range: 0-640). Junior residents received 79.5% of pages. Timing of the pages was 43.9% weekday shift, 31.8% weeknight shift, and 24.3% weekend call. Communication priority was deemed low for 35.4% of pages, medium for 32.3%, high for 12.4%, and immediate for 0.7%. Content analysis of 1062 pages generated 5 major themes: nonurgent medical issue (54.0%), administrative (15.3%), communication (13.5%), emergencies (4.8%), and GS consultation requests (4.0%). Priority and content of pages varied according to training level and page timing. CONCLUSIONS Pages to GS residents were frequent and most often of low priority. They were seldom related to urgent medical matters. Education and new communication strategies are warranted to reduce low priority pages.
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Affiliation(s)
- Julie Hallet
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Evaluative Clinical Sciences, Toronto, Ontario, Canada.
| | - David Wallace
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Abraham El-Sedfy
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Najma Ahmed
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Andrew J Smith
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Avery B Nathens
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Evaluative Clinical Sciences, Toronto, Ontario, Canada
| | - Lesley Gotlib Conn
- Sunnybrook Research Institute, Evaluative Clinical Sciences, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Evaluative Clinical Sciences, Toronto, Ontario, Canada
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Brenner M, Connolly M, Cawley D, Howlin F, Berry J, Quinn C. Family and healthcare professionals' perceptions of a pilot hospice at home programme for children: a qualitative study. BMC Palliat Care 2016; 15:89. [PMID: 27793144 PMCID: PMC5084337 DOI: 10.1186/s12904-016-0161-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/19/2016] [Indexed: 12/01/2022] Open
Abstract
Background Parents commonly report a significant improvement in quality of life following the provision of hospice and supportive care and have identified a need for such a service in the home. The purpose of this study was to understand the experiences of families receiving a nurse led pilot hospice at home programme and the experiences of healthcare professionals delivering and engaging with the programme. Methods An exploratory, qualitative study was conducted, including telephone interviews with parents and focus groups and individual interviews with healthcare professionals. All parents of families who received the programme of care between June 2014 and September 2015 and healthcare professionals delivering and engaging with the programme were invited to participate. Results Seven parents participated in telephone interviews. Four focus groups took place, two with external stakeholders (18 participants in total), one with in-patient hospice staff (13 participants) and one with the hospice at home team (8 participants). Two additional interviews took place with individual stakeholders who were unable to attend a scheduled focus group. Themes from interviews with parents focused on the value of having consistent and expert care. The findings from healthcare professionals centred on communication within and across services, education and training and lone working. Conclusions The pilot hospice at home programme was welcomed by all those who took part in the study. The programme may be improved by enhanced clarification of roles, enhanced access to multi-disciplinary services, greater communication across services and improved information provision to families.
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Affiliation(s)
- Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street,, Dublin 2, Ireland.
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Des Cawley
- Department of Nursing and Health Science, Athlone Institute of Technology, Athlone, Ireland
| | - Frances Howlin
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Jay Berry
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Matharu J, Hale B, Ammar M, Brennan PA. Short message service (SMS) texting as a method of communication during on call: prevalence and experience of medical staff in a large acute NHS Trust in the UK. Br J Oral Maxillofac Surg 2016; 54:863-867. [PMID: 27400819 DOI: 10.1016/j.bjoms.2016.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 05/07/2016] [Indexed: 10/21/2022]
Abstract
With the widespread use of smartphones, text messaging has become an accepted form of communication for both social and professional use in medicine. To our knowledge no published studies have assessed the prevalence and use of short message service (SMS) texting by doctors on call. We have used an online questionnaire to seek information from doctors in a large NHS Trust in the UK about their use of texting while on call, what they use it for, and whether they send images relevant to patients' care. We received 302 responses (43% response rate), of whom 166 (55%) used SMS while on call. There was a significant association between SMS and age group (p=0.005), with the 20-30-year-old group using it much more than the other age groups. Doctors in the surgical specialties used it significantly less than those in other speciality groups (p<0 .001). Texting while on call was deemed to be safe and reliable (p<0.001). Eighteen clinicians (11%) admitted to routinely sending images of patients by text, despite some being identifiable. Texting was mainly used to update colleagues on patients' progress and give information about times of ward rounds and meetings. With the increasing use of texting in healthcare, much of which seems to be unregulated, further work and detailed guidance is required on what information may be given to ensure confidentiality and that SMS is a safe and acceptable method of communication to use when on call.
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Affiliation(s)
- J Matharu
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - B Hale
- Senior Lecturer in Statistics and Research, University of Chichester, Chichester, UK
| | - M Ammar
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - P A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK.
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Leading article: Use of smartphones to pass on information about patients - what are the current issues? Br J Oral Maxillofac Surg 2016; 54:596-9. [DOI: 10.1016/j.bjoms.2016.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/19/2016] [Indexed: 11/20/2022]
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Patel B, Johnston M, Cookson N, King D, Arora S, Darzi A. Interprofessional Communication of Clinicians Using a Mobile Phone App: A Randomized Crossover Trial Using Simulated Patients. J Med Internet Res 2016; 18:e79. [PMID: 27052694 PMCID: PMC4838756 DOI: 10.2196/jmir.4854] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 12/05/2015] [Accepted: 01/04/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most hospitals use paging systems as the principal communication system, despite general dissatisfaction by end users. To this end, we developed an app-based communication system (called Hark) to facilitate and improve the quality of interpersonal communication. OBJECTIVE The objectives of our study were (1) to assess the quality of information transfer using pager- and app-based (Hark) communication systems, (2) to determine whether using mobile phone apps for escalation of care results in additional delays in communication, and (3) to determine how end users perceive mobile phone apps as an alternative to pagers. METHODS We recruited junior (postgraduate year 1 and 2) doctors and nurses from a range of specialties and randomly assigned them to 2 groups who used either a pager device or the mobile phone-based Hark app. We asked nurses to hand off simulated patients while doctors were asked to receive handoff information using these devices. The quality of information transfer, time taken to respond to messages, and users' satisfaction with each device was recorded. Each participant used both devices with a 2-week washout period in between uses. RESULTS We recruited 22 participants (13 nurses, 9 doctors). The quality of the referrals made by nurses was significantly better when using Hark (Hark median 118, range 100-121 versus pager median 77, range 39-104; P=.001). Doctors responded to messages using Hark more quickly than when responding to pagers, although this difference was not statistically significant (Hark mean 86.6 seconds, SD 96.2 versus pager mean 136.5 seconds, SD 201.0; P=.12). Users rated Hark as significantly better on 11 of the 18 criteria of an information transfer device (P<.05) These included "enhances interprofessional efficiency," "results in less disturbance," "performed desired functions reliably," and "allows me to clearly transfer information." CONCLUSIONS Hark improved the quality of transfer of information about simulated patients and was rated by users as more effective and efficient, and less distracting than pagers. Using this device did not result in delay in patient care.
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Affiliation(s)
- Bhavesh Patel
- Department of Surgery and Cancer, St Mary's Campus, Imperial College London, London, United Kingdom.
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Goldman J, Reeves S, Wu R, Silver I, MacMillan K, Kitto S. A sociological exploration of the tensions related to interprofessional collaboration in acute-care discharge planning. J Interprof Care 2016; 30:217-25. [PMID: 26852628 DOI: 10.3109/13561820.2015.1072803] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient discharge is a key concern in hospitals, particularly in acute care, given the multifaceted and challenging nature of patients' healthcare needs. Policies on discharge have identified the importance of interprofessional collaboration, yet research has described its limitations in this clinical context. This study aimed to extend our understanding of interprofessional interactions related to discharge in a general internal medicine setting by using sociological theories to illuminate the existence of, and interplay between, structural factors and microlevel practices. An ethnographic approach was employed to obtain an in-depth insight into healthcare providers' perspectives, behaviours, and interactions regarding discharge. Data collection involved observations, interviews, and document analysis. Approximately 65 hours of observations were undertaken, 23 interviews were conducted with healthcare providers, and government and hospital discharge documents were collected. Data were analysed using a directed content approach. The findings indicate the existence of a medically dominated division of healthcare labour in patient discharge with opportunities for some interprofessional negotiations; the role of organizational routines in facilitating and challenging interprofessional negotiations in patient discharge; and tensions in organizational priorities that impact an interprofessional approach to discharge. The findings provide insight into the various levels at which interventions can be targeted to improve interprofessional collaboration in discharge while recognizing the organizational tensions that challenge an interprofessional approach.
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Affiliation(s)
- Joanne Goldman
- a Centre for Quality Improvement and Patient Safety, Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Scott Reeves
- b Centre for Health & Social Care Research , Kingston University & St. George's, University of London , London , UK
| | - Robert Wu
- c Division of General Internal Medicine, Toronto General Hospital, University Health Network, and Department of Medicine, Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Ivan Silver
- d Centre for Addiction and Mental Health, Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Kathleen MacMillan
- e School of Nursing, Dalhousie University , Halifax , Nova Scotia , Canada
| | - Simon Kitto
- f Department of Innovation in Medical Education, Faculty of Medicine , University of Ottawa , Ottawa , Ontario , Canada
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Hoonpongsimanont W, Kulkarni M, Tomas-Domingo P, Anderson C, McCormack D, Tu K, Chakravarthy B, Lotfipour S. Text messaging versus email for emergency medicine residents' knowledge retention: a pilot comparison in the United States. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2016; 13:36. [PMID: 27780350 PMCID: PMC5121189 DOI: 10.3352/jeehp.2016.13.36] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 10/25/2016] [Indexed: 05/22/2023]
Abstract
We evaluated the effectiveness of text messaging versus email, as a delivery method to enhance knowledge retention of emergency medicine (EM) content in EM residents. We performed a multi-centered, prospective, randomized study consisting of postgraduate year (PGY) 1 to PGY 3 & 4 residents in three United States EM residency programs in 2014. Fifty eight residents were randomized into one delivery group: text message or email. Participants completed a 40 question pre- and post-intervention exam. Primary outcomes were the means of pre- and post-intervention exam score differences. Data were analyzed using descriptive statistics, paired t-test, and multiple linear regressions. No significant difference was found between the primary outcomes of the two groups (P=0.51). PGY 2 status had a significant negative effect (P=0.01) on predicted exam score difference. Neither delivery method enhanced resident knowledge retention. Further research on implementation of mobile technology in residency education is required.
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Affiliation(s)
- Wirachin Hoonpongsimanont
- Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, CA, USA
- *Corresponding
| | - Miriam Kulkarni
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Pedro Tomas-Domingo
- Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, CA, USA
| | - Craig Anderson
- Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, CA, USA
| | - Denise McCormack
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Khoa Tu
- Department of Emergency Medicine, Kern Medical Center, Bakersfield, CA, USA
| | - Bharath Chakravarthy
- Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, CA, USA
| | - Shahram Lotfipour
- Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, CA, USA
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Aungst TD, Belliveau P. Leveraging mobile smart devices to improve interprofessional communications in inpatient practice setting: A literature review. J Interprof Care 2015; 29:570-8. [DOI: 10.3109/13561820.2015.1049339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Eikey EV, Reddy MC, Kuziemsky CE. Examining the role of collaboration in studies of health information technologies in biomedical informatics: A systematic review of 25 years of research. J Biomed Inform 2015; 57:263-77. [DOI: 10.1016/j.jbi.2015.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 07/31/2015] [Accepted: 08/05/2015] [Indexed: 10/23/2022]
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18
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Wu R, Lo V, Morra D, Appel E, Arany T, Curiale B, Ryan J, Quan S. A smartphone-enabled communication system to improve hospital communication: usage and perceptions of medical trainees and nurses on general internal medicine wards. J Hosp Med 2015; 10:83-9. [PMID: 25352429 DOI: 10.1002/jhm.2278] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/04/2014] [Accepted: 10/10/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is increasing interest in the use of information and communication technologies to improve how clinicians communicate in hospital settings. METHODS We implemented a communication system with support for physician handover and secure messaging on 2 general internal medicine wards. We measured usage and surveyed physicians and nurses on perceptions of the system's effects on communication. RESULTS Between May 2011 and August 2012, a clinical teaching team received, on average, 14.8 messages per day through the system. Messages were typically sent as urgent (69.1%) and requested a text reply (76.5%). For messages requesting a text reply, 8.6% did not receive a reply. For those messages that did receive a reply, the median response time was 2.3 minutes, and 84.5% of messages received a reply within 15 minutes. Of those who completed the survey, 95.3% were medical residents (82 of 86) and 81.7% were nurses (83 of 116). Medical trainees (82.8%) and nursing staff (78.3%) agreed or strongly agreed that the system helped to speed up their daily work tasks. Overall, 67.1% of the trainees and 73.2% of nurses agreed or strongly agreed that the system made them more accountable in their clinical roles. Only 35.8% of physicians and 26.3% of nurses agreed or strongly agreed that the system was useful for communicating complex issues. CONCLUSIONS In summary, with a system designed to improve communication, we found that there was high uptake and that users perceived that the system improved efficiency and accountability but was not appropriate for communicating complex issues.
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Affiliation(s)
- Robert Wu
- Centre for Innovation in Complex Care, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of General Internal Medicine, University Health Network, Toronto, Canada
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Iribarren SJ, Beck SL, Pearce PF, Chirico C, Etchevarria M, Rubinstein F. MHEALTH INTERVENTION DEVELOPMENT TO SUPPORT PATIENTS WITH ACTIVE TUBERCULOSIS. JOURNAL OF MOBILE TECHNOLOGY IN MEDICINE 2014; 3:16-27. [PMID: 26246859 PMCID: PMC4523302 DOI: 10.7309/jmtm.3.2.4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Mobile Health (mHealth) based interventions have been increasingly used to improve a broad range of health outcomes. However, few researchers have reported on the process or the application of theory to guide the development of mHealth based interventions, or specifically for tuberculosis (TB) treatment management. AIMS To describe the steps, process, and considerations in developing a text messaging-based intervention to promote treatment adherence and provide support to patients with active TB. METHODS Traditional qualitative techniques, including semi-structured interviews, field notes, content analysis, iterative coding, and thematic analysis, were used to design and document the intervention development with a multidisciplinary team of researchers, clinicians, administrators, and patients who were in active TB treatment. The Information-Motivation-Behavioral Skills (IMB) model was used to guide the coding scheme for content analysis of patient-directed TB educational material and intervention development. RESULTS The development steps included: a) establishing intervention components, including justifications, considerations, timing and frequency of components; b) developing educational messages, including cultural adaption, text or short message service (SMS) formatting, and prioritizing message delivery order; and c) determining implementation protocol. A set of 16 IMB-based messages were developed for the educational component. Final intervention development was achieved in 3 months. CONCLUSION A collaborative approach and application of a theory to guide the intervention design and development is supported. Although a collaborative approach was more time consuming, it resulted in a more responsive, culturally appropriate, and comprehensive intervention. Considerations for developing a text messaging based intervention are provided and may serve as a guide for similar interventions. Further empirical evidence is needed for applying the IMB model for adherence-promotion in TB efforts.
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Affiliation(s)
- Sarah J Iribarren
- Columbia University School of Nursing, New York, NY, USA ; University of Utah, College of Nursing, Salt Lake City, UT, USA
| | - Susan L Beck
- University of Utah, College of Nursing, Salt Lake City, UT, USA
| | | | | | | | - Fernando Rubinstein
- Institute for Clinical Effectiveness and Healthcare Policy, Buenos Aires, Argentina
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