title: An evaluation of the use of smartphones to communicate between clinicians: a mixed-methods study.
abstract: BACKGROUND
  Communication between clinicians is critical to providing quality patient care but is often hampered by limitations of current systems. Smartphones such as BlackBerrys may improve communication, but studies of these technologies have been limited to date.
  
  
  OBJECTIVE
  Our objectives were to describe how smartphones were adopted for clinical communication within general internal medical wards and determine their impact on team effectiveness and communication.
  
  
  METHODS
  This was a mixed-methods study that gathered data from the frequency of smartphone calls and email messages, clinicians' interviews, and ethnographic observations of clinical communication interactions. Triangulation of qualitative and quantitative data was undertaken to develop common themes that encompass comprehensive and representative insights across different methods.
  
  
  RESULTS
  Findings from our study indicated that over a 24-hour period, nurses sent on average 22.3 emails to the physicians mostly through the "team smartphone," the designated primary point of contact for a specific medical team. Physicians carrying the team smartphone received on average 21.9 emails and 6.4 telephone calls while sending out 6.9 emails and initiating 8.3 telephone calls over the 24-hour period. Our analyses identified both positive and negative outcomes associated with the use of smartphones for clinical communication. There was a perceived improvement in efficiency over the use of pagers for clinical communication for physicians, nurses, and allied health professionals. In particular, residents found that the use of smartphones helped to increase their mobility and multitasking abilities. Negative outcomes included frequent interruptions and discordance between what doctors and nurses considered urgent. Nurses perceived a worsening of the interprofessional relationships due to overreliance on messaging by text with a resulting decrease in verbal communication. Unprofessional behaviors were observed in the use of smartphones by residents.
  
  
  CONCLUSIONS
  Routine adoption of smartphones by residents appeared to improve efficiency over the use of pagers for physicians, nurses, and allied health professionals. This was balanced by negative communication issues of increased interruptions, a gap in perceived urgency, weakened interprofessional relationships, and unprofessional behavior. Further communication interventions are required that balance efficiency and interruptions while maintaining or even improving interprofessional relationships and professionalism.
authors.affiliation: Division of General Internal Medicine, University Health Network, 200 Elizabeth Street, Toronto, Ontario, Canada. robert.wu@uhn.on.ca
authors.forename: Robert
authors.initials: R
authors.lastname: Wu
authors.forename: Peter
authors.initials: P
authors.lastname: Rossos
authors.forename: Sherman
authors.initials: S
authors.lastname: Quan
authors.forename: Scott
authors.initials: S
authors.lastname: Reeves
authors.forename: Vivian
authors.initials: V
authors.lastname: Lo
authors.forename: Brian
authors.initials: B
authors.lastname: Wong
authors.forename: Mark
authors.initials: M
authors.lastname: Cheung
authors.forename: Dante
authors.initials: D
authors.lastname: Morra
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D040421:Cell Phone / Q000706:statistics & numerical data*; D003299:Cooperative Behavior; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000706:statistics & numerical data*; D009864:Ontario; D010820:Physicians / Q000706:statistics & numerical data*; D017748:Time Management / Q000379:methods*; D016526:Workload / Q000706:statistics & numerical data