Technological aspects of hospital communication challenges: an observational study

Objective: To gain insights into how technological communication tools impact effective communication among clinicians, which is critical for patient safety.

Design: This multi-site observational study analyzes inter-clinician communication and interaction with information technology, with a focus on the critical process of patient transfer from the Emergency Department to General Internal Medicine.

Setting: Mount Sinai Hospital, Sunnybrook Health Sciences Centre and Toronto General Hospital.

Participants: At least five ED and general internal medicine nurses and physicians directly involved in patient transfers were observed on separate occasions at each institution.

Interventions: N/A.

Main outcome measures: N/A.

Results: The study provides insight into clinician workflow, evaluates current hospital communication systems and identifies key issues affecting communication: interruptions, issues with numeric pagers, lack of integrated communication tools, lack of awareness of consultation status, inefficiencies related to the paper chart, unintuitive user interfaces, mixed use of electronic and paper systems and lack of up-to-date contact information. It also identifies design trade-offs to be negotiated: synchronous communication vs. reducing interruptions, notification of patient status vs. reducing interruptions and speed vs. quality of handovers.

Conclusions: The issues listed should be considered in the design of new technology for hospital communications.