title: Technological aspects of hospital communication challenges: an observational study.
abstract: OBJECTIVE
  To gain insights into how technological communication tools impact effective communication among clinicians, which is critical for patient safety.
  
  
  METHODS
  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.
  
  
  METHODS
  Mount Sinai Hospital, Sunnybrook Health Sciences Centre and Toronto General Hospital.
  
  
  METHODS
  At least five ED and general internal medicine nurses and physicians directly involved in patient transfers were observed on separate occasions at each institution.
  
  
  METHODS
  N/A.
  
  
  METHODS
  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.
authors: Institute of Biomaterials and Biomedical Engineering, Faculty of Medicine, University of Toronto, Toronto, ON, Canada Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada M5G 2C4.
authors: Ilinca
authors: I
authors: Popovici
authors: Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada M5G 2C4.
authors: Plinio P
authors: PP
authors: Morita
authors: Nursing Health Services Research Unit, University of Toronto, Bloomberg Faculty of Nursing, Toronto, ON, Canada M5T 1P8.
authors: Diane
authors: D
authors: Doran
authors: Division of Respirology, UHN-MSH, Toronto, ON, Canada M5G 1X5.
authors: Stephen
authors: S
authors: Lapinsky
authors: Trillium Health Partners, Mississauga, ON, Canada L5B 1B8.
authors: Dante
authors: D
authors: Morra
authors: Institute of Biomaterials and Biomedical Engineering, Faculty of Medicine, University of Toronto, Toronto, ON, Canada Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada M5G 2C4.
authors: Ashleigh
authors: A
authors: Shier
authors: Division of General Internal Medicine, University Health Network, Toronto, ON, Canada M5G 2C4.
authors: Robert
authors: R
authors: Wu
authors: Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada M5G 2C4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors: Joseph A
authors: JA
authors: Cafazzo
mesh_terms: D001364:Awareness; D003142:Communication; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006739:Hospital Administration; D006801:Humans; D007256:Information Systems; D008505:Medical Staff, Hospital / Q000458:organization & administration; D009741:Nursing Staff, Hospital / Q000458:organization & administration; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*; D013996:Time and Motion Studies; D057188:Workflow
keywords: communication; emergency medicine; information systems; internal medicine; observation; patient handoff