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Appl Clin Inform 2022; 13(02): 391-397
DOI: 10.1055/s-0042-1744389
Research Article

Qualitative Analysis of Team Communication with a Clinical Texting System at a Midwestern Academic Hospital

Joy L. Lee
1   Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
2   Regenstrief Institute, Inc., Indianapolis, Indiana, United States
,
Areeba Kara
3   Indiana University Health Methodist Hospital, Indianapolis, Indiana, United States
,
Monica Huffman
2   Regenstrief Institute, Inc., Indianapolis, Indiana, United States
,
Marianne S. Matthias
1   Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
2   Regenstrief Institute, Inc., Indianapolis, Indiana, United States
4   Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, United States
,
Bethany Radecki
3   Indiana University Health Methodist Hospital, Indianapolis, Indiana, United States
,
April Savoy
2   Regenstrief Institute, Inc., Indianapolis, Indiana, United States
4   Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, United States
5   Department of Computer Information and Graphic Technology, Purdue School of Engineering and Technology, Indianapolis, Indiana, United States
,
Jason T. Schaffer
3   Indiana University Health Methodist Hospital, Indianapolis, Indiana, United States
,
Michael Weiner
1   Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
2   Regenstrief Institute, Inc., Indianapolis, Indiana, United States
4   Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, United States
› Author Affiliations Funding This work was supported by the cross-center pilot award of the Regenstrief Institute, Inc., and the Indiana Clinical and Translational Sciences Institute, via the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award (grant numbers UL1TR001108 and UL1TR002529).
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Abstract

Background Hospitals are increasingly replacing pagers with clinical texting systems that allow users to use smartphones to send messages while maintaining compliance for privacy and security. As more institutions adopt such systems, the need to understand the impact of such transitions on team communication becomes ever more significant.

Methods We conducted focus groups with hospitalists and individual interviews with nurses at one academic medical center in the Midwest. All interviews and focus groups were audiorecorded, transcribed, and deidentified for analysis. All transcripts and notes were independently read by two members of the research team and coded for themes.

Results Twenty-one hospitalists and eight nurses participated in the study. Although study participants spoke favorably of texting, they identified more dissatisfactions with texting than benefits. There were disagreements regarding appropriate texting practices both within and between the hospitalists and nurses.

Conclusion Despite the benefits of texting, there is room for improving team communication and understanding in the realm of clinical texting. A lack of shared understanding regarding when and how to use texting may require long-term solutions that address teamwork and appropriateness.

Keywords

messaging - qualitative research - care teams - communication

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and was reviewed by the Indiana University Institutional Review Board.


Supplementary Material



Publication History

Received: 29 September 2021

Accepted: 06 February 2022

Article published online:
16 March 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 TigerText.. The hidden cost of pagers in healthcare: How outmoded technology is draining healthcare IT budgets. 2016: 1-7 Accessed February 17, 2022 at: https://www.tigerconnect.com/wp-content/uploads/Report-Hidden-Cost-of-Pagers.pdf
    PubMedGoogle Scholar
  • 2 Kuhlmann S, Ahlers-Schmidt CR, Steinberger E. TXT@WORK: pediatric hospitalists and text messaging. Telemed J E Health 2014; 20 (07) 647-652
    CrossrefPubMedGoogle Scholar
  • 3 McKnight R, Franko O. HIPAA compliance with mobile devices among ACGME programs. J Med Syst 2016; 40 (05) 129
    CrossrefPubMedGoogle Scholar
  • 4 Dietz AS, Pronovost PJ, Mendez-Tellez PA. et al. A systematic review of teamwork in the intensive care unit: what do we know about teamwork, team tasks, and improvement strategies?. J Crit Care 2014; 29 (06) 908-914
    CrossrefPubMedGoogle Scholar
  • 5 Randmaa M, Mårtensson G, Leo Swenne C, Engström M. SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study. BMJ Open 2014; 4 (01) e004268
    CrossrefPubMedGoogle Scholar
  • 6 Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C. Improving communication in the ICU using daily goals. J Crit Care 2003; 18 (02) 71-75
    CrossrefPubMedGoogle Scholar
  • 7 Williams M, Hevelone N, Alban RF. et al. Measuring communication in the surgical ICU: better communication equals better care. J Am Coll Surg 2010; 210 (01) 17-22
    CrossrefPubMedGoogle Scholar
  • 8 Neily J, Mills PD, Young-Xu Y. et al. Association between implementation of a medical team training program and surgical mortality. JAMA 2010; 304 (15) 1693-1700
    CrossrefPubMedGoogle Scholar
  • 9 Martin G, Khajuria A, Arora S, King D, Ashrafian H, Darzi A. The impact of mobile technology on teamwork and communication in hospitals: a systematic review. J Am Med Inform Assoc 2019; 26 (04) 339-355
    CrossrefPubMedGoogle Scholar
  • 10 Lags in Interoperability and Enterprise Mobile Tech Strategy Don't Impede Secure Messaging Adoption, Black Book Cybersecurity Survey;. 2018 . Accessed December 23, 2021 at: https://www.prnewswire.com/news-releases/lags-in-interoperability-and-enterprise-mobile-tech-strategy-dont-impede-secure-messaging-adoption-black-book-cybersecurity-survey-300663841.html
    PubMed
  • 11 Liu X, Sutton PR, McKenna R. et al. Evaluation of secure messaging applications for a health care system: a case study. Appl Clin Inform 2019; 10 (01) 140-150
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 O'Leary KJ, Liebovitz DM, Wu RC. et al. Hospital-based clinicians' use of technology for patient care-related communication: a national survey. J Hosp Med 2017; 12 (07) 530-535
    CrossrefPubMedGoogle Scholar
  • 13 Ayanian JZ, Markel H. Donabedian's lasting framework for health care quality. N Engl J Med 2016; 375 (03) 205-207
    CrossrefPubMedGoogle Scholar
  • 14 Donabedian A. The quality of care. How can it be assessed?. JAMA 1988; 260 (12) 1743-1748
    CrossrefPubMedGoogle Scholar
  • 15 Borkan J. Immersion/Crystallization. In: Crabtree BF, Miller WL, eds. Doing Qualitative Research. Chapter 10. Thousand Oaks, CA: Sage Publications, Inc.; 1999: 179-194
    Google Scholar
  • 16 Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods 2006; 18 (01) 59-82
    CrossrefPubMedGoogle Scholar
  • 17 Bernard H. Research Methods in Anthropology: Qualitative and Quantitative Approaches. Lanham, CA: AltaMira Press; 2002
    Google Scholar
  • 18 Miles M, Huberman A. Qualitative data analysis. Thousand Oaks, CA: Sage; 1994
    Google Scholar
  • 19 Miller WL, Crabtree BF. The dance of interpretation. In: Crabtree BF, Miller WL, eds. Doing Qualitative Research. Sage; 1999: 179-194
    Google Scholar
  • 20 Reader TW, Flin R, Mearns K, Cuthbertson BH. Interdisciplinary communication in the intensive care unit. Br J Anaesth 2007; 98 (03) 347-352
    CrossrefPubMedGoogle Scholar
  • 21 Miller PA. Nurse-physician collaboration in an intensive care unit. Am J Crit Care. 2001; 10 (05) 341-350
    PubMedGoogle Scholar
  • 22 Manojlovich M, Harrod M, Hofer T, Lafferty M, McBratnie M, Krein SL. Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study. BMJ Qual Saf 2021; 30 (09) 747-754
    CrossrefPubMedGoogle Scholar
  • 23 Patel MS, Patel N, Small DS. et al. Change in length of stay and readmissions among hospitalized medical patients after inpatient medicine service adoption of mobile secure text messaging. J Gen Intern Med 2016; 31 (08) 863-870
    CrossrefPubMedGoogle Scholar
  • 24 Patel N, Siegler JE, Stromberg N, Ravitz N, Hanson CW. Perfect storm of inpatient communication needs and an innovative solution utilizing smartphones and secured messaging. Appl Clin Inform 2016; 7 (03) 777-789
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Lo V, Wu RC, Morra D, Lee L, Reeves S. The use of smartphones in general and internal medicine units: a boon or a bane to the promotion of interprofessional collaboration?. J Interprof Care 2012; 26 (04) 276-282
    CrossrefPubMedGoogle Scholar
  • 26 Shanafelt TD, Dyrbye LN, Sinsky C. et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc 2016; 91 (07) 836-848
    CrossrefPubMedGoogle Scholar
  • 27 Apathy NC, Harle CA, Vest JR, Morea J, Menachemi N. Use of electronic health records on days off: comparing physicians to other EHR users. J Gen Intern Med 2021; 36 (04) 1140-1143
    CrossrefPubMedGoogle Scholar
  • 28 Safe use of health information technology. Sentinel Event Alert 2015; (54) 1-6
    PubMedGoogle Scholar