Breaking Barriers to Effective In-Hospital

CommunicationOmar Metwally, MD

St. Mary’s Medical Center Grand RoundsOctober 8th 2015

Disclosure● I have no conflicts of interest to disclose

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Goals● Illustrate problematic in-hospital communication with three cases● Present advantages and disadvantages of communication tools currently

used at St. Mary’s● Review literature on in-hospital communication systems● Provide a glimpse into solutions

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● 30 yoM with DM2 complicated by osteomyelitis s/p toe amputations, diabetic nephropathy, CKD III and systolic heart failure who was transferred from St. Francis for podiatry care

● Initial plan for 48 hrs of ongoing vancomycin for MRSA osteomyelitis s/p transmetatarsal amputation per PROS recommendations

● Outside records were ambiguous○ Baseline Cr of 2.3? vs Cr 1.8 on admission○ Creatinine was 2.5 with K 5.8 on hospital day 2

● Vancomycin trough checked on HD 2: 58.7; suspended on HD 4● Hemodialysis started on HD 5

Case 1: Mr. μ

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What’s wrong with this picture?Source: Highlights Kids

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Case 2: Ms. τ● Healthy 83 yoF admitted with R hand swelling & pain● Orthopedic surgery attempted to aspirate R wrist in ED

unsuccessfully● This was communicated by night team during sign out● Day team discharged her on antibiotics for cellulitis● Orthopedic surgery contacted Medicine recommending that

patient remain in hospital to work up septic arthritis

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What’s wrong with this picture?Source: Highlights Kids

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Case 3: Ms. Σ ● 66 yoF with CAD s/p CABG and multiple stents, DM2, chronic

lymphedema and LE ulcers, directly admitted by PROS ● PROS requested that medicine assume primary

responsibility for patient● Patient was on the floor for hours without any paper or

electronic records● No attending to attending or resident to resident sign out● No medication list available

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Survey Prompt #1

Examples where technology helps you communicate with colleagues

Examples where technology hinders your ability to communicate effectively

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Survey Prompt #2What do you think of the current paging system?

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Survey Prompt #3What do you think of Medisas?

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Survey Prompt #4What is the biggest communication-related problem we have at St. Mary’s?

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An Evaluation of the Use of Smartphones to Communicate Between Clinicians: A Mixed-

Methods StudyJ Med Internet Res. 2011 Jul-Sep; 13(3): e59.

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Future Directions

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Take-Home Points● First do no harm● Technology is used inconsistently within a hospital

● Organizational programming is at least as important as the techology!

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Thank you!

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References1. Przybylo JA et al. Smarter hospital communication: secure smartphone text messaging improves provider

satisfaction and perception of efficacy, workflow. J Hosp Med. 2014 Sep;9(9):573-8.

2. Sehgal NL et al. Patient whiteboards as a communication tool in the hospital setting: a survey of practices and recommendations. J Hosp Med. 2010 Apr;5(4):234-9.

3. The consequences of poor communication during transitions from hospital to skilled nursing facility: a qualitative study. J Am Geriatr Soc. 2013 Jul;61(7):1095-102. King BJ1, Gilmore-Bykovskyi AL, Roiland RA, Polnaszek BE, Bowers BJ, Kind AJ.

4. Ighani F et al. A comparison of two-way text versus conventional paging systems in an academic ophthalmology department. J Med Syst. 2010 Aug;34(4):677-84.

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5. Wu RC et al. Effects of clinical communication interventions in hospitals: a systematic review of information and communication technology adoptions for improved communication between clinicians. Int J Med Inform. 2012 Nov;81(11):723-32.

6. Nguyen C et al. The use of technology for urgent clinician to clinician communications: a systematic review of the literature. Int J Med Inform. 2015 Feb;84(2):101-10.

7. McElroy LM et al. The role of technology in clinician-to-clinician communication. BMJ Qual Saf. 2013 Dec;22(12):981-3.

8. Wu R et al. An evaluation of the use of smartphones to communicate between clinicians: a mixed-methods study. J Med Internet Res. 2011 Aug 29;13(3):e59.

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