Optimizing inter-professional communications in surgery: protocol for a mixed-methods exploratory study.
BACKGROUND
Effective nurse-physician communication is critical to delivering high quality patient care. Interprofessional communication between surgical nurses and surgeons, often through the use of pagers, is currently characterized by information gaps and interprofessional tensions, both sources of workflow interruption, potential medical error, impaired educational experience, and job satisfaction.


OBJECTIVE
This study aims to define current patterns of, and understand enablers and barriers to interprofessional communication in general surgery, in order to optimize the use of communication technologies, teamwork, provider satisfaction, and quality and safety of patient care.


METHODS
We will use a mixed-methods multiphasic approach. In phase 1, a quantitative and content analysis of alpha-numeric pages (ANP) received by general surgery residents will be conducted to develop a paging taxonomy. Frequency, timing (on-call vs regular duty hours), and interval between pages will be described using a 4-week sample of pages. Results will be compared between pages sent to junior and senior residents. Finally, using an inductive analysis, two independent assessors will classify ANP thematically. In Phase 2, a qualitative constructivist approach will explore stakeholders' experiences with interprofessional communication, including paging, through interviews and shadowing of 40 residents and 40 nurses at two institutions. Finally, a survey will be developed, tested, and administered to all general surgery nurses and residents at the same two institutions, to evaluate their attitudes about the effectiveness and quality of interprofessional communication, and assess their satisfaction.


RESULTS
Describing the profile of current pages is the first step towards identifying areas and root causes of IPC inefficiency. This study will identify key contextual barriers to surgical nurse-house staff communication, and existing interprofessional knowledge and practice gaps.


CONCLUSIONS
Our findings will inform the design of a guideline and tailored intervention to improve IPC in order to ensure high quality patient care, optimal educational experience, and provider satisfaction.
Sunnybrook Health Sciences Centre, Division of General Surgery, Toronto, ON, Canada.
Julie
http://orcid.org/0000-0001-5108-1072
J
Hallet
David
http://orcid.org/0000-0002-1564-9027
D
Wallace
Abraham
http://orcid.org/0000-0001-7957-1137
A
El-Sedfy
Trevor Nt
http://orcid.org/0000-0003-1068-3442
TN
Hall
Najma
http://orcid.org/0000-0003-4922-6652
N
Ahmed
Jennifer
http://orcid.org/0000-0003-2226-2987
J
Bridge
Ru
http://orcid.org/0000-0002-5050-7796
R
Taggar
Andy J
http://orcid.org/0000-0002-3582-8292
AJ
Smith
Avery B
http://orcid.org/0000-0003-3785-3800
AB
Nathens
Natalie G
http://orcid.org/0000-0002-5313-717X
NG
Coburn
Lesley
http://orcid.org/0000-0003-3769-5590
L
Gotlib-Conn
communication; education; interprofessional; nurse; pager; patient safety; resident