Clinical communication is complex and breakdowns in communication are cited as the leading cause of medical errors. The issues include inefficient team communication, paging disruption, not being able to identify the most responsible physician, and delays in communicating critical laboratory values, to name a few. As these issues with communication are not unique to the University Health Network, we have collaborated with Mount Sinai Hospital to develop the Interprofessional Communication Tool (IP Tool). The goal of the IP Tool will be address the many inefficient communication processes within an integrated communications framework.
The Interprofessional Communication Tool will provide tools that enhance communication among disciplines (physician-physician) but also allow effective communication across disciplines (nurse-physician). It will also integrate with mobile devices such as the BlackBerry smartphone as our clinicians are becoming more mobile and require solutions that facilitate this workflow. The tool will address several high level themes:
1. Promote Patient Centred Care
Interprofessional collaboration centres on the needs of the patient and this system will be built with the patient as the single unique entity. Functionality will be built to reflect the different workflows of our multiple specialties and services, but everything will link back to the patient as a single entity irrespective of workflow. We will also provide functionality to allow the patient and/or their family to have a better understanding of their overall care plan and to be more involved in the care process.
2. Facilitate Hand-over Communication
The primary component and the main interface of the IP Tool will be hand-over tools for the various disciplines. The purpose of these tools will be to communicate patient details such as past medical history and active issues from one shift to the other as coverage changes. Each discipline will have their own interface built to meet their specific workflow but all of this data is linked and shared across the entire tool to allow Interprofessional collaboration.
3. Reduce Disruptive Communication
Paging is the primary method of communicating issues to medical teams, whether it is for urgent or non-urgent matters. To reduce disruption caused by paging, we will create functionality to allow management and triaging of non-urgent tasks that ensures they are effectively communicated and completed.
4. Accurately Identify the Most Responsible Clinician
This will be a key feature for ensuring the entire care team is aware who is following a patient and who should be contacted for specific issues. We envision the ability to automatically forward communication to the appropriate clinician 24/7 based on coverage to reduce errant and lost messages. This will also improve efficiency of care since delays in communication of issues to someone who can address them will be reduced.
5. Mobile Device Integration
Mobile devices for sending and receiving communication will be a key for this initiative. This includes integration with our internal email system, integration with our internal phone system so the mobile devices act like the phones we have at our desk, and the ability to interact with the IP Tool to close the loop on communication.
6. Closed Loop Communication
All functionality and processes built into the system will have mechanisms in place to ensure the loop on communication is closed. Information will be available so the clinician can quickly make informed decisions, tasks or issues are addressed and acted upon in a timely fashion, and gaps in communication that lead to the omission of important information are eliminated. This includes managing tasks that although are not urgent, still need to be completed and/or addressed.
Dr. Howard Abrams
Dr. Dante Morra
University Health Network
Sunnybrook Health Sciences Centre
Mount Sinai Hospital