Arielle Mendel1,2, Anthony Lott3, Lisha Lo4, Robert Wu3,5. 1. Division of General Internal Medicine, Department of Medicine, University Health Network, Toronto, Ontario, Canada. ariellemendel@gmail.com. 2. Division of Rheumatology, Department of Medicine, McGill University, Montreal, Quebec; Canada. 3. Division of General Internal Medicine, Department of Medicine, University Health Network, Toronto, Ontario, Canada. 4. Centre for Quality Improvement and Patient Safety, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 5. Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Text messaging is increasingly replacing paging as a tool to reach physicians on medical wards. However, this phenomenon has resulted in high volumes of nonurgent messages that can disrupt the learning climate. OBJECTIVE: Our objective was to reduce nonurgent educational interruptions to residents on general internal medicine. DESIGN, SETTING, PATIENTS: This was a quality improvement project conducted at an academic hospital network. Measurements and interventions took place on 8 general internal medicine inpatient teaching teams. INTERVENTION: Interventions included (1) refining the clinical communication process in collaboration with nursing leadership; (2) disseminating guidelines with posters at nursing stations; (3) introducing a noninterrupting option for message senders; (4) audit and feedback of messages; (5) adding an alert for message senders advising if a message would interrupt educational sessions; and (6) training and support to nurses and residents. MEASUREMENTS: Interruptions (text messages, phone calls, emails) received by institution-supplied team smartphones were tracked during educational hours using statistical process control charts. A 1-month record of text message content was analyzed for urgency at baseline and following the interventions. RESULTS: The interruption frequency decreased from a mean of 0.92 (95% CI, 0.88 to 0.97) to 0.59 (95% CI, 0.51 to0.67) messages per team per educational hour from January 2014 to December 2016. The proportion of nonurgent educational interruptions decreased from 223/273 (82%) messages over one month to 123/182 (68%; P < .01). CONCLUSIONS: Creation of communication guidelines and modification of text message interface with feedback from end-users were associated with a reduction in nonurgent educational interruptions. Continuous audit and feedback may be necessary to minimize nonurgent messages that disrupt educational sessions.
BACKGROUND: Text messaging is increasingly replacing paging as a tool to reach physicians on medical wards. However, this phenomenon has resulted in high volumes of nonurgent messages that can disrupt the learning climate. OBJECTIVE: Our objective was to reduce nonurgent educational interruptions to residents on general internal medicine. DESIGN, SETTING, PATIENTS: This was a quality improvement project conducted at an academic hospital network. Measurements and interventions took place on 8 general internal medicine inpatient teaching teams. INTERVENTION: Interventions included (1) refining the clinical communication process in collaboration with nursing leadership; (2) disseminating guidelines with posters at nursing stations; (3) introducing a noninterrupting option for message senders; (4) audit and feedback of messages; (5) adding an alert for message senders advising if a message would interrupt educational sessions; and (6) training and support to nurses and residents. MEASUREMENTS: Interruptions (text messages, phone calls, emails) received by institution-supplied team smartphones were tracked during educational hours using statistical process control charts. A 1-month record of text message content was analyzed for urgency at baseline and following the interventions. RESULTS: The interruption frequency decreased from a mean of 0.92 (95% CI, 0.88 to 0.97) to 0.59 (95% CI, 0.51 to0.67) messages per team per educational hour from January 2014 to December 2016. The proportion of nonurgent educational interruptions decreased from 223/273 (82%) messages over one month to 123/182 (68%; P < .01). CONCLUSIONS: Creation of communication guidelines and modification of text message interface with feedback from end-users were associated with a reduction in nonurgent educational interruptions. Continuous audit and feedback may be necessary to minimize nonurgent messages that disrupt educational sessions.
Authors: Daniel B Heppe; Albertine S Beard; Paul B Cornia; Tyler J Albert; Azadeh Lankarani-Fard; Joel M Bradley; Michelle M Guidry; Brian Kwan; Anand Jagannath; Matthew Tuck; Kathlyn E Fletcher; Elizabeth S Gromisch; Craig G Gunderson Journal: J Gen Intern Med Date: 2020-08-10 Impact factor: 5.128
Authors: Tyler J Albert; Joel Bradley; Helene Starks; Jeff Redinger; Cherinne Arundel; Albertine Beard; Laura Caputo; Jonathan Chun; Craig G Gunderson; Dan Heppe; Anand Jagannath; Kyle Kent; Michael Krug; James Laudate; Vignesh Palaniappan; Amanda Pensiero; Zaven Sargsyan; Emily Sladek; Matthew Tuck; Paul B Cornia Journal: J Gen Intern Med Date: 2021-06-25 Impact factor: 6.473