title: Smartphones let surgeons know WhatsApp: an analysis of communication in emergency surgical teams.
abstract: BACKGROUND
  Outdated communication technologies in healthcare can place patient safety at risk. This study aimed to evaluate implementation of the WhatsApp messaging service within emergency surgical teams.
  
  
  METHODS
  A prospective mixed-methods study was conducted in a London hospital. All emergency surgery team members (n = 40) used WhatsApp for communication for 19 weeks. The initiator and receiver of communication were compared for response times and communication types. Safety events were reported using direct quotations.
  
  
  RESULTS
  More than 1,100 hours of communication pertaining to 636 patients were recorded, generating 1,495 communication events. The attending initiated the most instruction-giving communication, whereas interns asked the most clinical questions (P < .001). The resident was the speediest responder to communication compared to the intern and attending (P < .001). The participants felt that WhatsApp helped flatten the hierarchy within the team.
  
  
  CONCLUSIONS
  WhatsApp represents a safe, efficient communication technology. This study lays the foundations for quality improvement innovations delivered over smartphones.
authors.affiliation: Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK. Electronic address: m.johnston@imperial.ac.uk.
authors.forename: Maximilian J
authors.initials: MJ
authors.lastname: Johnston
authors.affiliation: Centre for Health Policy, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK.
authors.forename: Dominic
authors.initials: D
authors.lastname: King
authors.affiliation: Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK.
authors.forename: Sonal
authors.initials: S
authors.lastname: Arora
authors.affiliation: Department of Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: Nebil
authors.initials: N
authors.lastname: Behar
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.affiliation: Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D040421:Cell Phone; D004632:Emergency Medical Services / Q000458:organization & administration*; D013502:General Surgery / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D063731:Mobile Applications; D010348:Patient Care Team / Q000458:organization & administration*; D061214:Patient Safety; D011446:Prospective Studies; D013997:Time Factors
keywords: Communication; Information technology; Patient safety; Surgery; mHealth