title: Optimizing Patient Surgical Management Using WhatsApp Application in the Italian Healthcare System.
abstract: Smartphones changed the method by which doctors communicate with each other, offer modern functionalities sensitive to the context of use, and can represent a valuable ally in the healthcare system. Studies have shown that WhatsApp™ application can facilitate communication within the healthcare team and provide the attending physician a constant oversight of activities performed by junior team members. The aim of the study was to use WhatsApp between two distant surgical teams involved in a program of elective surgery to verify if it facilitates communication, enhances learning, and improves patient care preserving their privacy.
  
  
  
  We conducted a focused group of surgeons over a 28-month period (from March 2013 to July 2015), and from September 2014 to July 2015, a group of selected specialists communicated healthcare matters through the newly founded "WhatsApp Surgery Group." Each patient enrolled in the study signed a consent form to let the team communicate his/her clinical data using WhatsApp. Communication between team members, response times, and types of messages were evaluated.
  
  
  
  Forty six (n = 46) patients were enrolled in the study. A total of 1,053 images were used with an average of 78 images for each patient (range 41-143). 125 h of communication were recorded, generating 354 communication events. The expert surgeon had received the highest number of questions (P, 0.001), while the residents asked clinical questions (P, 0.001) and were the fastest responders to communications (P, 0.001).
  
  
  
  Our study investigated how two distant clinical teams may exploit such a communication system and quantifies both the direction and type of communication between surgeons. WhatsApp is a low cost, secure, and fast technology and it offers the opportunity to facilitate clinical and nonclinical communications, enhance learning, and improve patient care preserving their privacy.
authors.affiliation: 1 Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna , Italy .
authors.forename: Bruno
authors.initials: B
authors.lastname: Nardo
authors.affiliation: 2 Department of Surgery, Annunziata Hospital of Cosenza , Cosenza, Italy .
authors.forename: Marco
authors.initials: M
authors.lastname: Cannistrà
authors.affiliation: 3 Department of Medical and Surgical Sciences, University of Catanzaro , Italy .
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Diaco
authors.affiliation: 3 Department of Medical and Surgical Sciences, University of Catanzaro , Italy .
authors.forename: Agostino
authors.initials: A
authors.lastname: Naso
authors.affiliation: 1 Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna , Italy .
authors.forename: Matteo
authors.initials: M
authors.lastname: Novello
authors.affiliation: 3 Department of Medical and Surgical Sciences, University of Catanzaro , Italy .
authors.forename: Alessandra
authors.initials: A
authors.lastname: Zullo
authors.affiliation: 3 Department of Medical and Surgical Sciences, University of Catanzaro , Italy .
authors.forename: Michele
authors.initials: M
authors.lastname: Ruggiero
authors.affiliation: 3 Department of Medical and Surgical Sciences, University of Catanzaro , Italy .
authors.forename: Raffaele
authors.initials: R
authors.lastname: Grande
authors.affiliation: 3 Department of Medical and Surgical Sciences, University of Catanzaro , Italy .
authors.forename: Rosario
authors.initials: R
authors.lastname: Sacco
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D003219:Confidentiality; D005260:Female; D017144:Focus Groups; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D007558:Italy; D008297:Male; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D008875:Middle Aged; D063731:Mobile Applications; D010348:Patient Care Team / Q000592:standards*; D011787:Quality of Health Care; D000068997:Smartphone; D013997:Time Factors; D055815:Young Adult
keywords: WhatsApp™ application; communications; elective surgery; liver disease; patient care; privacy