title: Interprofessional Communication of Clinicians Using a Mobile Phone App: A Randomized Crossover Trial Using Simulated Patients.
abstract: BACKGROUND
  Most hospitals use paging systems as the principal communication system, despite general dissatisfaction by end users. To this end, we developed an app-based communication system (called Hark) to facilitate and improve the quality of interpersonal communication.
  
  
  OBJECTIVE
  The objectives of our study were (1) to assess the quality of information transfer using pager- and app-based (Hark) communication systems, (2) to determine whether using mobile phone apps for escalation of care results in additional delays in communication, and (3) to determine how end users perceive mobile phone apps as an alternative to pagers.
  
  
  METHODS
  We recruited junior (postgraduate year 1 and 2) doctors and nurses from a range of specialties and randomly assigned them to 2 groups who used either a pager device or the mobile phone-based Hark app. We asked nurses to hand off simulated patients while doctors were asked to receive handoff information using these devices. The quality of information transfer, time taken to respond to messages, and users' satisfaction with each device was recorded. Each participant used both devices with a 2-week washout period in between uses.
  
  
  RESULTS
  We recruited 22 participants (13 nurses, 9 doctors). The quality of the referrals made by nurses was significantly better when using Hark (Hark median 118, range 100-121 versus pager median 77, range 39-104; P=.001). Doctors responded to messages using Hark more quickly than when responding to pagers, although this difference was not statistically significant (Hark mean 86.6 seconds, SD 96.2 versus pager mean 136.5 seconds, SD 201.0; P=.12). Users rated Hark as significantly better on 11 of the 18 criteria of an information transfer device (P<.05) These included "enhances interprofessional efficiency," "results in less disturbance," "performed desired functions reliably," and "allows me to clearly transfer information."
  
  
  CONCLUSIONS
  Hark improved the quality of transfer of information about simulated patients and was rated by users as more effective and efficient, and less distracting than pagers. Using this device did not result in delay in patient care.
authors.affiliation: Department of Surgery and Cancer, St Mary's Campus, Imperial College London, London, United Kingdom. bhavesh.patel07@imperial.ac.uk.
authors.forename: Bhavesh
authors.identifier: http://orcid.org/0000-0002-8664-2287
authors.initials: B
authors.lastname: Patel
authors.forename: Maximilian
authors.identifier: http://orcid.org/0000-0002-1280-4335
authors.initials: M
authors.lastname: Johnston
authors.forename: Natalie
authors.identifier: http://orcid.org/0000-0003-0487-2634
authors.initials: N
authors.lastname: Cookson
authors.forename: Dominic
authors.identifier: http://orcid.org/0000-0002-1898-842X
authors.initials: D
authors.lastname: King
authors.forename: Sonal
authors.identifier: http://orcid.org/0000-0002-8345-9049
authors.initials: S
authors.lastname: Arora
authors.forename: Ara
authors.identifier: http://orcid.org/0000-0001-7815-7989
authors.initials: A
authors.lastname: Darzi
mesh_terms: D040421:Cell Phone; D003142:Communication; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008505:Medical Staff, Hospital; D063731:Mobile Applications; D009741:Nursing Staff, Hospital; D062209:Patient Handoff; D016544:Patient Simulation; D012017:Referral and Consultation
keywords: applications; apps; communication; escalation of care; mobile phone; pager; simulation