Better communications using mobile email improve patient care

The use of wireless email increases efficiency in the delivery of healthcare and builds a greater degree of teamwork, according to the director of medical informatics at Trillium Health Centre in Mississauga ON. The facility's staff use BlackBerry devices to deal with patient-related communications. "Healthcare workers have a continuous need to communicate," said Chris O'Connor, a critical care physician. "They are workers who are always on the move and are never just sitting around waiting for something to happen. They are mobile. They can be moving from patient to patient. They are doing multiple things at once."Speaking in Toronto at a conference focused on health information privacy and security, O'Connor explained that patient care and changes in patient status drive the information flow and ongoing communications between healthcare employees. At the Trillium Health Centre, which contains a 26-bed intensive care unit, staff communications wasn't always efficient and was antiquated. Previously used methods included hunting down other members of the healthcare team, sending messages via a third party, using an intercom system, sending numeric pages, and listing the request on the physician "ask list" which is checked once per day. But it was after an incident where O'Connor nearly caused the death of a patient that he began consideration of an alternative communication means that would be more effective, less interruptive, and reduce the potential for medical error. "I thought there must be a better of way communicating," he said. "I was being interrupted, and it was being in a disruptive milieu that led to the mistake."Passed studies have proven that poor communications among medical staff can lead to medial error, and others have shown that communications among medical personnel is inefficient. To deal with this problem, the Trillium Health Centre began using an email system where non-urgent questions could be answered by physicians using any desktop in the hospital. The project worked to some degree, but there were still delays and disruptions since hospital staff had to search for computers to log in to retrieve their e-mail. It wasn't 2005 when the facility undertook a pilot project using mobile email that it realized improvements in communications and patient care. Trillium launched a trial of wireless email using 39 BlackBerry devices donated by Research in Motion. Rogers Wireless also donated the airtime. The pilot project ran from August 2005 until January 2006 and involved 126 clinical staff. Many employees, including physicians, nurses, pharmacists, respiratory therapists, social workers, dieticians, unit clerks, and intensive care unit administrative staff, were equipped with the 7290 Blackberry to communicate among each other. Participants were asked to rate the use of the Blackberry on a seven-point Likert scale and they gave the Blackberry an overall rating of 6.1 in favour of continuing to use it at work. Participants gave the device a rating of 5.7 in improving patient care, 5.4 in improving patient safety, and 5.8 in terms of improved response time."The response was universally positive," said O'Connor. "There were some naysayers when we started to use the devices, but staff found that the more they used it, the more they liked it."The use of secure wireless e-mail permits requests to be triaged by senior medical staff, so an intensivist or another specialist, is not interrupted for matters that are not urgent. "There is instantaneous transmission of content-rich messages," he said. "We can respond in real-time and not be geographically limited by being somewhere else in the hospital. As a clinician, you can look at a message and triage it appropriately. Most of the time I can reply right away. This increases the turnaround time in response to patients' needs."O'Connor has observed that the use of the handheld devices has engendered more critical thinking on the part of medical staff and most of his e-mail responses as confirmations of treatment plans from nurses and other medical staff. "There has been a change in the interaction between nurses and physicians," he said. "The day-to-day issues in patient care are handled via e-mail. Most of my e-mail is telling people to go ahead with their ideas. It never occurred to me that I would be giving orders this way. When we do actual medical rounds, we can now deal with more complicated issues."All the email messages transmitted via the handheld devices are stored on a central computer with only few individuals, such as key information technology staff, having access to them, he explained. The cost of implementing secure wireless email, which O'Connor puts at $16,000 annually, brings a lot of bang for the buck, he said. The cost would be further reduced if a Wi-Fi network were used, he added.

Better communications using mobile email improve patient care

News | March 30, 2007

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