Transforming Communication in Health Care via Information Technology: Implementation of a free telephone directory app

doi:10.21203/rs.3.rs-1534258/v1

Download PDF

Research Article

Transforming Communication in Health Care via Information Technology: Implementation of a free telephone directory app

https://doi.org/10.21203/rs.3.rs-1534258/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this older preprint version

Read the latest preprint version →

Background:

Timely communication is key to patient safety and management in health care. Communication failure and delays in the transfer of information between healthcare workers can result in avoidable errors. We measured the effect of the implementation of a free telephone directory app for hospital staff to connect efficiently within the hospital.

Methods:

We implemented a free telephone directory app for smartphones which is available to all hospital staff that provides immediate access to all the internal phone lines and bleeps without calling switch. An audit of telephone calls made to switch before and after the implementation of the app was then performed.

Results:

Number of total calls to switch board in a 24hour period reduced by 10.9% (2,248 to 2,002 calls) following implementation of the app. The proportion of calls to switch which were from an internal line with staff requesting the number of an internal line or bleep was also reduced from 29.9% (n=672) to 24.6% (n=492), p-value <0.001.

Conclusion:

The use of a hospital phone directory app with mobile technology is a cost-effective measure that can benefit the hospital by improving efficiency in hospital switchboards, enhance communication and productivity for healthcare workers which can help improve patient care.

Hospital Medicine

Communication

Healthcare

Patient Care

Mobile Technology

Smart Phone

Effective communication has a crucial role in delivery of safe quality care to patients in healthcare. Recent technological advancements provide new ways to effectively communicate and share information within the healthcare setting. The delivery of safe high-quality healthcare is a complex task, requiring intensive collaboration with effective and efficient communication. Failure in communication has been associated with more than half of medical errors ^[1] and the delayed transfer of information between healthcare workers has been shown to result in avoidable errors and inefficiencies in patient care ^[2].

Smart phones are used by most healthcare professionals, with one study demonstrating up to 92% of doctors reporting regular daily use during work ^[3]. The use of smart phones in healthcare settings has been shown to improve efficiency in communication and result in faster response times during delivery of time critical care ^[4.5]. Smart phone software applications” apps” can provide immediate access to time-critical information. Despite the increasing availability and acceptability of smartphone technology, the main tool healthcare workers use to find contact information for hospital locations remains the hospital switchboard.

We measured the effect of the implementation of a free telephone directory app for hospital staff to connect efficiently within different hospital areas at the Mater Misericordiae University Hospital.

Following approval from the Hospital Ethics Board, we implemented a telephone directory app, Induction, (InductionⒸ , Version 7.10.1 Podmedics Ltd, Induction Healthcare Ltd. UK) in the Mater Misericordiae University Hospital in December 2020. This app is available to all hospital staff and provides immediate access to all the internal phone lines and bleeps. No personal phone numbers nor patient details were accessible on the app, in accordance with GDPR. The app allows staff to call internal phone numbers directly from their personal handsets without using the hospital switchboard as an intermediary.

Printed posters containing app information were placed in common areas for staff, and emails were circulated to advertise the app. An audit of telephone calls over a common 24-hour period made to the hospital switchboard before (November 2020) and after (February 2021) the implementation of the app was performed. Switchboard staff collected this data which included 4 categories:

Total number of calls
Number of calls from internal line requesting a bleep or phone number.
Number of calls from external line
Other types of call

This data was analysed using the statistical analysis software, R-Project (R-Project Ⓒ ). A Proportion test of Equality was used to test the prespecified null hypothesis that the proportion of number of calls from internal lines requesting bleep and phone extension number are the same prior to and following implementation of the app.

Subsequently, the Chi-square test of independence was used to assess whether implementation of the app had an impact on all 4 categories.

In total, 2,248 phone calls to switchboard were recorded over a 24-hour period prior to implementation of the app. The total number of phone calls reduced by 10.9% following implementation of the app to 2,002 phone calls (Fig. 1).

There was a statistically significant reduction in the proportion of phone calls to switch from an internal line to request for bleep numbers or phone extension numbers from 672 (29.9%) to 492 (24.6%) post implementation (p < 0.001) (Fig. 2).

The proportion of phone calls from external lines increased from 55.8–57.2%. There was also an increase in the proportion of calls from inside line requesting to be transferred to outside line and the proportion of other calls (Table 1).

Table 1

Number of calls to MMUH switch board in 24-hour period (November 2020 vs February 2021; pre and post implementation of “Induction” telephone directory app)
	Total Number of calls. (Fig. 1)	Number of calls from external line.	Number of calls from internal line requesting bleep number/phone numbers. (Fig. 2)	Number of calls from internal line requesting to be transferred to external line.	Number of “other” calls.
Pre-Implementation	2,248	1,255 (55.8%)	672 (29.9%)	217 (9.7%)	104 (4.6%)
Post-Implementation	2,002	1,145 (57.2%)	492 (24.6%)	236 (11.8%)	129 (6.4%)

A Chi-square test of independence demonstrated that the implementation of the app resulted in a statistically significant change in all 4 categories following implementation of the app (χ² = 22.19, p-value < 0.001).

Mobile devices have become an essential part of healthcare workers lives inside and outside of work. Smart phones have capabilities that allow rapid and immediate access to information for healthcare workers. They have been shown to allow for rapid communication and improved accessibility and responsiveness of staff ⁶. Studies have shown that most healthcare workers believe smart phones should be integrated within hospital systems.^7,8. The delivery of high-quality, safe, and effective healthcare is an intricate task that requires the careful and precise collaboration between numerous healthcare professionals in the care of a single patient.

The hospital switchboard plays a central role in the provision of services in hospital. In addition to linking health professionals to one another, they also connect patients and relatives to their healthcare providers. They coordinate communication during emergencies and critical events and hence play a critical role within the hospital.

A recent audit showed that only 36% of 219 of UK hospitals switchboard met the 20 second target response time ^{[ 9]}. Response time is a key goal and measure of efficiency for switchboards ^[9]. Over-reliance on hospital switchboard personnel uses significant manpower resources and contributes to delays in addressing calls and queries for non-directory related services. The use of hospital switchboard for directory queries may also delay effective communication between healthcare professionals, which may lead to delays in patient care and clinical decision making. Reducing the call burden therefore helps to improve response time, resulting in increased efficiency in communication between healthcare providers.

Our study demonstrates that the implementation of a contact directory app resulted in a statistically significant reduction in the proportion of internal phone calls to the hospital switchboard to request for bleep and hospital extension numbers (p < 0.001). The implementation of the contact directory app resulted in a 10.9% (246) reduction in total phone calls to the hospital switchboard. This shifted the workload from the hospital switchboard and resulted in an increased proportion of calls to the switchboard from external lines, and from internal calls requesting to be transferred to external lines. The 24-hour control and testing periods that was studied incorporated a similar timeframe during the working week, however heterogeneity may be difficult to determine due to possible variations in hospital workload during the Covid-19 pandemic setting.

The use of mobile devices in healthcare can lead to improvements in workflow, efficiency, and effective communication. Several studies have demonstrated that the use of smart phones has led to more effective communication by demonstrating improvements in the quality of clinical discussion ^[10], improvements in patient care ^[11], and faster response times ^[12]. Another study demonstrated that smartphones generated additional value by enabling a straightforward delivery of nonurgent information while also assisting in the triage, prioritization, and rapid communication in urgent situations in the healthcare setting ^[13]. The utilisation of smart phones can not only improve the efficiency and effectiveness of communication between healthcare workers, but it can also reduce interruptions in patient care in hospitals ^[12]. In addition to improved efficiency and quality of communication, mobile devices can also have a positive impact on interprofessional interactions between healthcare workers and improve decision making process as key decision makers are more easily accessible ^[14].

Despite the multiple benefits on the use of smart phones in the hospital setting, concerns regarding providing a distraction for healthcare workers and potentially giving healthcare workers an unprofessional appearance in hospitals have been reported ^[15]. Several other limitations on the use of mobile devices in the healthcare setting have been reported. This includes the poor battery life and unreliable connectivity in the hospital setting which can limit its effectiveness ^{[4, 12, 13]}. A 2019 systematic review on the use of mobile technology in hospital setting showed that the use of mobile technology enhanced communication and teamwork in the hospital setting and its limitations was scarce ^[6]. Despite some negative reports on the use of mobile devices in the healthcare setting, the systematic review concluded that mobile devices acted to remove barriers for effective communication. In one study 85% of healthcare workers recommended the widespread use of mobile devices ^[10] and in another study 92% agreed that there is significant potential for the integration of mobile devices in the hospital setting ^[16].

One of the major concerns with using personal mobile devices routinely in healthcare is the potential risk to the confidentiality and security of patients and staff members ^[17]. Despite this negative consequence of mobile devices, many studies have showed healthcare workers strongly support the use a mobile devices in the healthcare setting and strongly encourage their wider use in hospitals ^{[3, 7, 8]}. This highlights the importance healthcare workers perceive the use of mobile devices for their work in the healthcare system. The contact directory app we implemented contained no personal information of staff, or patients. This smart phone app allows staff members to find the hospital contact extension or bleep number they wish to request without the necessity of have to contact the hospital switchboard to request their desired contact number. This allows healthcare workers to utilise the benefit of the improved effectiveness and efficiency in communication because of the smart phone app, with no risk to their confidentiality and personal security.

The use of smart phones in healthcare may require healthcare organisations to develop policies and guidelines on their use to help guide healthcare workers towards their safe and effective utilisation. Many individual healthcare organisation may not have such policies implemented for their personnel on the use of smart phone routinely in their organisation. National advice on the use of mobile technology in the healthcare setting by the health service executive (HSE) which is the governance body of health services in Ireland is available and they have produced online guidance on the use of mobile technology, and social media in healthcare. They acknowledge that “smart phone use is ubiquitous” and that “social media is currently being used by many HSE departments and staff and for both internal and external communication” ^[18]. This can help healthcare organisations embrace the “mobile-first” culture within their organisation and provide the required leadership and motivation to implement change in their organising by utilising smart phones to improve efficiency and effective communication while being mindful on the risk of their use in healthcare.

Healthcare workers use innovative technology both inside and outside of work, yet frequently resort to outdated methods to use a directory in the hospital setting to coordinate and deliver care to patients. The requirement for immediate and accurate communication between healthcare workers in the hospital setting, together with the potentially harmful consequences of delayed or inaccurate communication means that modern technology for improving communication must continue to be studied robustly. Our study demonstrates a potential use of mobile technology in the hospital setting and more resources and leadership is required to embrace the current digital age to lead to further innovation and quality improvement.

The use of a hospital phone directory app with mobile technology is a cost-effective measure that can deliver clear benefit to the hospital setting by improving efficiency in hospital switchboards, enhance communication and productivity for healthcare workers, and can help improve patient care.

Ethics approval and consent to participate was not applicable in our study.

Consent for publication- Not applicable in our study as no patient data collected.

All data generated and analysed during this study are included in this published article. This data was collected over two separate 24-hour period by the hospital switchboard.

There were no competing interests in this study.

Authors contributions- AH analysed and interpreted the patient data. RB, RH and EB collected patient data. AH and AN main contributors to writhing the manuscript. All authors read and approved the final manuscript.

Street RL, Petrocelli JV, Amroze A, et al. How Communication “Failed” or “Saved the Day”: Counterfactual Accounts of Medical Errors. Journal of Patient Experience. December 2020:1247-1254. doi:10.1177/2374373520925270
Woolf SH, Kuzel AJ, Dovey SM, Phillips RL Jr. A string of mistakes: the importance of cascade analysis in describing, counting, and preventing medical errors. Ann Fam Med. 2004 Jul-Aug;2(4):317-26. doi: 10.1370/afm.126
Martin G, Janardhanan P, Withers T, Gupta S. Mobile revolution: a requiem for bleeps? Postgrad Med J. 2016 Sep;92(1091):493-6. doi: 10.1136/postgradmedj-2015-133722. Epub 2016 Feb 24. PMID: 26912500
Power J, Spina S, Forbes D, et al. Integration of smartphones into clinical pharmacy practice: an evaluation of the impact on pharmacists’ efficiency. Health Policy Technol 2014; 3 (4): 296–305.
Wu R, Rossos P, Quan S, et al. An evaluation of the use of smartphones to communicate between clinicians: a mixed-methods study. J Med Internet Res 2011; 13 (3): e59
Martin, Guy & Khajuria, Ankur & King, Dominic & Arora, Sonal & Ashrafian, Hutan & Darzi, Ara. (2018). The impact of mobile technology on teamwork and communication in hospitals: A systematic review. Journal of the American Medical Informatics Association. 26. 10.1093/jamia/ocy175.
Jamal A, Temsah MH, Khan SA, Al-Eyadhy A, Koppel C, Chiang MF. Mobile Phone Use Among Medical Residents: A Cross-Sectional Multicenter Survey in Saudi Arabia. JMIR Mhealth Uhealth. 2016 May 19;4(2):e61. doi: 10.2196/mhealth.4904.
Mobasheri M, King D, Johnston M, et al. The ownership and clinical use of smartphones by doctors and nurses in the UK: a multicentre survey study. BMJ Innov 2015; 1 (4): 174. doi:10.1136/bmjinnov-2015-000062
Shokrollahi K, Tadiparthi S, Jayagopal S. How fast is fast enough? An audit and league table of response times of acute hospital NHS Trust switchboards in England. J R Soc Med. 2008 Jul;101(7):364-71. doi: 10.1258/jrsm.2008.080006
Przybylo JA, Wang A, Loftus P, Evans KH, Chu I, Shieh L. Smarter hospital communication: secure smartphone text messaging improves provider satisfaction and perception of efficacy, workflow. J Hosp Med. 2014 Sep;9(9):573-8. doi: 10.1002/jhm.2228.
Motulsky A, Wong J, Cordeau JP, Pomalaza J, Barkun J, Tamblyn R. Using mobile devices for inpatient rounding and handoffs: an innovative application developed and rapidly adopted by clinicians in a pediatric hospital. J Am Med Inform Assoc. 2017 Apr 1;24(e1):e69-e78. doi: 10.1093/jamia/ocw107.
Webb C, Spina S, Young S. Integrating smartphone communication strategy and technology into clinical practice: A mixed methods research study. Health Policy Technol (2016)
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 Jul;26(4):276-82. doi: 10.3109/13561820.2012.663013.
Farrell M. Use of iPhones by Nurses in an Acute Care Setting to Improve Communication and Decision-Making Processes: Qualitative Analysis of Nurses' Perspectives on iPhone Use. JMIR Mhealth Uhealth. 2016 May 31;4(2):e43. doi: 10.2196/mhealth.5071.
Acute Care Setting to Improve Communication and Decision-Making Processes: Qualitative Analysis of Nurses' Perspectives on iPhone Use. JMIR Mhealth Uhealth. 2016 May 31;4(2):e43. doi: 10.2196/mhealth.5071.
Daruwalla Z, Wong K, Thambiah J. The application of telemedicine in orthopedic surgery in singapore: a pilot study on a secure, mobile telehealth application and messaging platform. J Med Internet Res 2014; 2 (2): e28.
Tran K, Morra D, Lo V, Quan S, Wu R. The use of smartphones on General Internal Medicine wards: a mixed methods study. Appl Clin Inform. 2014 Sep 10;5(3):814-23. doi: 10.4338/ACI-2014-02-RA-0011
Health Service Executive. HSE policies and procedures [Available from: http://www.hse.ie/eng/staff/Resources/socialmedia/ [accessed February 25^th2021]

Download PDF

Version 1

posted

You are reading this older preprint version

Read the latest preprint version →

Transforming Communication in Health Care via Information Technology: Implementation of a free telephone directory app

Status:

Version 1

Abstract

Figures

Background

Methods

Results

Discussion

Conclusion

Declarations

References

Status:

Version 1