title: Implementing web-based ping-pong-type e-communication to enhance staff satisfaction, multidisciplinary cooperation, and clinical effectiveness: A SQUIRE-compliant quality-improving study.
abstract: BACKGROUND
  Frequent multidisciplinary communication is essential in conducting daily radiotherapy (RT) practice. However, traditional oral or paper-based communication has limitations. E-communication has been suggested, but its effects are still not well demarcated in the field of radiation oncology.
  
  
  OBJECTIVE
  In our web-based integrated information platform, we constructed a ping-pong-type e-communication function to transfer specific notations among multidisciplinary RT staffs. The purpose was to test whether applying this e-communication can increase effectiveness of multidisciplinary cooperation when compared with oral or paper-based practice. Staff satisfaction and clinical benefits were also demonstrated.
  
  
  METHODS
  A real-world quality-improving study was conducted in a large center of radiation oncology.
  Before and after applying multidisciplinary e-communication (from 2014 to 2015), clinical RT staffs were surveyed for their user experience and satisfaction (n = 23). For measuring clinical effectiveness, a secondary database of irradiated head and neck cancer patients was re-analyzed for comparing RT toxicities (n = 402).
  
  
  METHODS
  Applying ping-pong-type multidisciplinary reflective e-communication was the main intervention.
  
  
  METHODS
  For measuring staff satisfaction, eight domains were surveyed, such as timeliness, convenience, and completeness. For measuring clinical effectiveness of multidisciplinary cooperation, event rates of severe (i.e., grade 3-4) RT mucositis and dermatitis were recorded.
  
  
  RESULTS
  Overall, when compared with oral communication only, e-communication demonstrated multiple benefits, particularly on notation-review convenience (2.00 ± 1.76 vs 9.19 ± 0.81; P < 0.0001).When compared with paper-based practice, e-communication showed statistically significant benefits on all eight domains, especially on notation-review convenience (5.05 ± 2.11 vs 9.19 ± 0.81; P < 0.0001) and convenience of feedback notation (4.81 ± 1.72 vs 8.76 ± 1.09; P < 0.0001).Moreover, staff satisfaction was gradually increased from oral (3.57 ± 1.94), paper-based (5.57 ± 2.06), to e-communication (8.76 ± 0.70; P < 0.0001). Secondary measurement confirmed these observations.Before and after facilitating multidisciplinary cooperation by using e-communication, severe (i.e., grade 3-4) mucositis and dermatitis were decreased from 21.7% to 10% then to 5.1%.
  
  
  CONCLUSIONS
  Replacing oral or paper-based practice with e-communication is useful in facilitating RT multidisciplinary teamwork. Staff satisfaction and clinical effectiveness can be increased.
authors.affiliation: Department of Radiation Oncology Section of Chest Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation Department of Radiation Oncology, Buddhist Tzu Chi General Hospital School of Medicine, Tzu Chi University, Hualien Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei Institute of Molecular Biology, National Chung Cheng University, Min-Hsiung, Chia-Yi, Taiwan, ROC.
authors.forename: Pei-Han
authors.initials: PH
authors.lastname: Yeh
authors.forename: Shih-Kai
authors.initials: SK
authors.lastname: Hung
authors.forename: Moon-Sing
authors.initials: MS
authors.lastname: Lee
authors.forename: Wen-Yen
authors.initials: WY
authors.lastname: Chiou
authors.forename: Chun-Liang
authors.initials: CL
authors.lastname: Lai
authors.forename: Wei-Ta
authors.initials: WT
authors.lastname: Tsai
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Hsieh
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Shih
authors.forename: Liang-Cheng
authors.initials: LC
authors.lastname: Chen
authors.forename: Li-Wen
authors.initials: LW
authors.lastname: Huang
authors.forename: Yi-An
authors.initials: YA
authors.lastname: Lin
authors.forename: Po-Hao
authors.initials: PH
authors.lastname: Lin
authors.forename: Yung-Hsiang
authors.initials: YH
authors.lastname: Lin
authors.forename: Dai-Wei
authors.initials: DW
authors.lastname: Liu
authors.forename: Feng-Chun
authors.initials: FC
authors.lastname: Hsu
authors.forename: Shiang-Jiun
authors.initials: SJ
authors.lastname: Tsai
authors.forename: Jia-Chi
authors.initials: JC
authors.lastname: Liu
authors.forename: En-Seu
authors.initials: ES
authors.lastname: Chung
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Lin
mesh_terms: D003142:Communication; D006801:Humans; D020407:Internet; D007588:Job Satisfaction; D010348:Patient Care Team; D058996:Quality Improvement; D018787:Radiation Oncology / Q000379:methods / Q000592:standards; D012189:Retrospective Studies