Subscribe to RSS
Understanding interprofessional communication: a content analysis of email communications between doctors and nurses
10 September 2011
accepted: 22 January 2012
16 December 2017 (online)
Background: Clinical communication is recognized as a major source of errors in hospitals. The lack of documentation of communication, especially among verbal interactions, often creates hindrances and impedes improvement efforts. By providing smartphones to residents and encouraging nurses to communicate with residents by email shifted much of the communication to emails which permitted analysis of content.
Objective: Description on the interprofessional email communication between doctors and nurses occurring on the general internal medicine wards at two academic hospitals.
Design: A prospective analysis of email communications between doctors and nurses.
Setting: 34 out of the 67 residents who were on the general medicine clinical teaching units consented to allow analysis of their emails over a 6 month period.
Main measures: Statistical tabulations were performed on the volume and frequency of communications as well the response time of messages. Two physicians coded the content of randomly selected emails for urgency, emotion, language, type of interaction, and subject content.
Key results: A total of 13,717 emails were available for analysis. Among the emails from nurses, 39.1% were requests for a call back, 18.9% were requests for a response by email and the remaining 42.0% indicated no response was required from physicians. For the messages requesting a response by email, only 50% received an email response. Email responses had a median response time of 2.3 minutes. Content analysis revealed that messages were predominantly non-urgent. The two most frequent purposes for communications were to convey information (91%) and to request action by the physician (36%).
Conclusions: A smartphone-based email system facilitated the description and content analysis of a large amount of email communication between physicians and nurses. Our findings provide a picture of the communication between physicians, nurses and other healthcare professionals. This work may help inform the further development of information and communications technology that can improve clinical communication.
- 1 Institute of Medicine (U.S.). Crossing the Quality Chasm: A New Health System for the 21st Century/Committee on Quality Health Care in America, Institute of Medicine. Washington: The National Academies Press; 2001
- 2 HIMSS Analytics. Essentials of the U.S. Hospital IT Market (fifth edition). Chicago, Il: HIMSS Analytics; 2010
- 3 Volpp KG, Grande D. Residents’ suggestions for reducing errors in teaching hospitals. N Engl J Med 2003; 348 (09) 851-855.
- 4 Wong BM, Quan S, Cheung CM, Morra D, Rossos PG, Sivjee K. et al. Frequency and clinical importance of pages sent to the wrong physician. Arch Intern Med 2009; 169 (11) 1072-1073.
- 5 Agarwal R, Sands DZ, Schneider JD. Quantifying the economic impact of communication inefficiencies in U. S. hospitals. J Healthc Manag 2010; 55 (04) 265-281.
- 6 Poor communication is common cause of errors. Healthcare Benchmarks Qual Improv 2002; 1 (Suppl. 02) 18-19.
- 7 Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The Quality in Australian Health Care Study. Med J Aust 1995; 163: 458-471.
- 8 Coiera E. When conversation is better than computation. J Am Med Inform Assoc 2000; 7 (03) 277-286.
- 9 Horwitz LI, Detsky AS. Physician communication in the 21st century: to talk or to text?. JAMA 2011; 305 (11) 1128-1129.
- 10 O’Connor C, Friedrich JO, Scales DC, Adhikari NK. The use of wireless email to improve healthcare team communication. J Am Med Inform Assoc 2009; 16 (05) 705-713.
- 11 Coiera E, Tombs V. Communication behaviours in a hospital setting: an observational study. BMJ 1998; 316 7132 673-676.
- 12 Anand SG, Feldman MJ, Geller DS, Bisbee A, Bauchner H, Anand SG. et al. A content analysis of e-mail communication between primary care providers and parents. Pediatrics 2005; 115 (05) 1283-1288.
- 13 Ye J, Rust G, Fry-Johnson Y, Strothers H. E-mail in patient-provider communication: a systematic review. Patient Educ Couns 2010; 80 (02) 266-273.
- 14 Wu R, Rossos P, Quan S, Reeves S, Lo V, Wong B. et al. An evaluation of the use of smartphones to communicate between clinicians: a mixed-methods study. J Med Internet Res 2011; 13 (03) e59.
- 15 Wu RC, Morra D, Quan S, Lai S, Zanjani S, Abrams H. et al. The use of smartphones for clinical communication on internal medicine wards. J Hosp Med 2010; 5 (09) 553-559.
- 16 Woloshynowych M, Davis R, Brown R, Vincent C. Communication patterns in a UK emergency department. Ann Emerg Med 2007; 50 (04) 407-413.
- 17 White CB, Moyer CA, Stern DT, Katz SJ. A content analysis of e-mail communication between patients and their providers: patients get the message. J Am Med Inform Assoc 2004; 11 (04) 260-267.
- 18 Stiles RA, Deppen SA, Figaro MK, Gregg WM, Jirjis JN, Rothman RL. et al. Behind-the-scenes of patient-centered care: content analysis of electronic messaging among primary care clinic providers and staff. Med Care 2007; 45 (12) 1205-1209.
- 19 Kuziemsky CE, Varpio L. Describing the Clinical Communication Space through a Model of Common Ground: ‘you don‘t know what you don‘t know‘. AMIA Annu Symp Proc 2010; 2010: 407-411.
- 20 Epley N, Kruger J. When what you type isn‘t what they read: the perseverance of stereotypes and expectancies over e-mail. Journal of Experimental Social Psychology 2005; 41: 414-422.
- 21 Kruger J, Epley N, Parker J, Ng ZW. Egocentrism over e-mail: can we communicate as well as we think?. J Pers Soc Psychol 2005; 89 (06) 925-936.
- 22 Mehrabian A. Nonverbal communication. Chicago: Aldine-Atherton; 1972
- 23 Menchik DA, Tian X. Putting Social Context into Text: The Semiotics of E-mail Interaction. American Journal of Sociology 2008; 114 (02) 332-370.
- 24 Reeves S, Rice K, Conn LG, Miller KL, Kenaszchuk C, Zwarenstein M. Interprofessional interaction, negotiation and non-negotiation on general internal medicine wards. J Interprof Care 2009; 1-13.