Smarter Hospital Team Communication: Smartphone Group Text Messaging Improves Efficacy, Workflow, and Provider Satisfaction
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Abstract
Background: Poor communication within healthcare teams can have serious consequences, with an estimated 66% of preventable medication errors attributed to provider miscommunication.1 Augmenting the relatively inflexible, limited-function pager with a more dynamic, group-oriented messaging modality may be one means by which communication can be improved. The smartphone is a particularly attractive solution in this regard due to its widespread use and advanced technological features, which include visual display capabilities, touch-screen technology, ease of use, and group messaging interfaces.
Objective: To determine if Medigram, a HIPAA-compliant group texting application for mobile phones, can improve the efficiency of communication within hospital healthcare teams.
Methods: In an 8-week prospective, randomized control cluster study at Stanford Hospital, three inpatient medicine teams were assigned to use Medigram in combination with hospital paging (experimental); two teams were assigned to use hospital paging (control). Each team included an attending, resident, case manager, two interns, and two medical students. Pre- and post-study surveys were collected from all study participants (22 control and 41 experimental team members) and analyzed in Stata and Qualtrics.
Results: When compared with paging (1=low, 5=high), the texting application was rated significantly more effective (p<0.05) in the following areas: allowing users to communicate thoughts clearly (paging=3.19, texting =3.81) and efficiently (paging=3.20, texting=3.83), and integrating into users’ workflow during work rounds (paging=2.31, texting=3.00) and patient discharge (paging=2.45, texting=3.28). Overall satisfaction with the texting application was also significantly higher (paging=2.81, texting =3.46, p=0.0043). The paging system was not rated more favorably in any area. When asked if they would recommend using such a HIPAA-compliant group texting application on the internal medicine service, 85% of experimental subjects replied “yes†and 15% replied “not sure.†A thematic analysis of free response questions using grounded theory yielded insight into aspects of the texting application that experimental subjects found most effective (ease of use, group texting feature, speed, instant access, and efficiency; 32%, 32%, 24%, 15%, and 12% of respondents, respectively) and least effective (lack of ubiquity, inconsistent staff usage, message transmission problems, and missed message alerts; 30%, 24%, 15%, and 12% of respondents, respectively). Of note is the fact that the aspects identified as ineffective could be explained in large part by limitations of the study rather than problems inherent to the application; in particular, the application was made available only to a small subset of the internal medicine department, participation was voluntary, and a key gathering area did not have wi-fi or 3G/4G coverage, resulting in missed messages.
Conclusions: HIPAA-compliant group texting applications for smartphones can improve provider perception of in-hospital communication, particularly if adoption is compulsory for all hospital staff and hospital wi-fi networks are well-developed.
Citations:
1 JCAHO. Sentinel Event Data: Root Causes by Event Type. (2006)
Objective: To determine if Medigram, a HIPAA-compliant group texting application for mobile phones, can improve the efficiency of communication within hospital healthcare teams.
Methods: In an 8-week prospective, randomized control cluster study at Stanford Hospital, three inpatient medicine teams were assigned to use Medigram in combination with hospital paging (experimental); two teams were assigned to use hospital paging (control). Each team included an attending, resident, case manager, two interns, and two medical students. Pre- and post-study surveys were collected from all study participants (22 control and 41 experimental team members) and analyzed in Stata and Qualtrics.
Results: When compared with paging (1=low, 5=high), the texting application was rated significantly more effective (p<0.05) in the following areas: allowing users to communicate thoughts clearly (paging=3.19, texting =3.81) and efficiently (paging=3.20, texting=3.83), and integrating into users’ workflow during work rounds (paging=2.31, texting=3.00) and patient discharge (paging=2.45, texting=3.28). Overall satisfaction with the texting application was also significantly higher (paging=2.81, texting =3.46, p=0.0043). The paging system was not rated more favorably in any area. When asked if they would recommend using such a HIPAA-compliant group texting application on the internal medicine service, 85% of experimental subjects replied “yes†and 15% replied “not sure.†A thematic analysis of free response questions using grounded theory yielded insight into aspects of the texting application that experimental subjects found most effective (ease of use, group texting feature, speed, instant access, and efficiency; 32%, 32%, 24%, 15%, and 12% of respondents, respectively) and least effective (lack of ubiquity, inconsistent staff usage, message transmission problems, and missed message alerts; 30%, 24%, 15%, and 12% of respondents, respectively). Of note is the fact that the aspects identified as ineffective could be explained in large part by limitations of the study rather than problems inherent to the application; in particular, the application was made available only to a small subset of the internal medicine department, participation was voluntary, and a key gathering area did not have wi-fi or 3G/4G coverage, resulting in missed messages.
Conclusions: HIPAA-compliant group texting applications for smartphones can improve provider perception of in-hospital communication, particularly if adoption is compulsory for all hospital staff and hospital wi-fi networks are well-developed.
Citations:
1 JCAHO. Sentinel Event Data: Root Causes by Event Type. (2006)
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