Direct cellular vs. indirect pager communication during orthopaedic surgical procedures: A prospective study

Abstract

Background: Cellular phone use within the hospital setting has increased as physicians, nurses, and ancillary staff incorporate wireless technologies in improving efficiencies, cost, and maintaining patient safety and high quality healthcare [11]. Through the use of wireless, cellular communication, an overall improvement in communication accuracy and efficiency between intraoperative orthopaedic surgeons and floor nurses may be achieved.Methods: Both communication types occurred while the surgeon was scrubbed in the operating room (OR). Indirect communication occurred when the pager call was answered by the OR circulating nurse with communication between the surgeon, circulating nurse, and floor nurse. Direct communication consisted of cell phone and Jabra Bluetooth BT200 wireless ear piece used by the surgeon. The surgeon answered the floor nurse's cellular call by phone ring-activated automatic answering. The study was conducted during scheduled orthopaedic procedures. An independent observer measured time variables with a stop-watch while orthopaedic nurses randomly called via pager or cell phone. The nurses asked for patient caregiver confirmation and answers to 30 different patient-care questions.Results: Sixty trials were performed with 30 cell and 30 page communications. Direct cellular communication showed a better response rate than indirect page (Cell 100%, Page 73%). Indirect page communication allowed a 27% and 33% error rate with patient problem and surgeon solution communications, respectively. There were no reported communication errors while using direct wireless, cellular communication.When compared to page communications, cellular communications showed statistically significant improvements in mean time intervals in response time (Cell = 11s, Page = 211s), correct patient identification (Cell = 5s, Page = 172s), patient problem and solution time (Cell = 13s, Page = 189s), and total communication time (Cell = 32s, Page = 250s) (s = seconds, all P < 0.001). Floor nurse satisfaction ratings (dependent on communication times and/or difficulties) were improved with direct cellular communication (Cell = 29 excellent, Page = 11 excellent). Intraoperative case interruptions (defined as delaying surgical progress) were more frequent with indirect page communication (10 page v. 0 cell).Conclusion and significance: Our study demonstrates that direct wireless communication may be used to improve intraoperative communication and enhance patient safety. Direct wireless, cellular intraoperative communication improves communication times, communication accuracy, communication satisfaction, and minimizes intraoperative case interruption. As a result of this study, we hope to maintain our transition to direct wireless, cellular intraoperative orthopaedic communication to reduce medical errors, improve patient care, and enhance both orthopaedic surgeon and nursing efficiencies.

The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis

“…For interventions using mobile technologies to communicate between health care providers for clinical/patient management, three trials [40],[43],[46] relied on the use of MMS for sending images by mobile phone, and one trial used the telephone function of the mobile phone [44]. One trial used MMS on a PDA.…”

“…Six trials [26],[34],[36],[38],[39] reported 17 medical process outcomes: perceived difficulty in performing a task (1 outcome) [39], use of tool (1) [36], errors in report (2), errors in score calculation (2) [34], completeness of reports (2) [38], time to complete a report (2) [38], time to record vital signs (1) [34], time to diagnosis (3) [26], and time to treatment (3) [26]. For interventions using mobile technologies to communicate between health care providers for clinical/patient management outcomes, six trials [40],[42]–[44],[46],[57] reported 19 outcomes relating to the quality of nurse surgeon communication (6 outcomes) [44], correct clinical assessment or diagnosis (4) [40],[43],[46], test score (1) [42] and electrocardiogram (ECG) transmission (8) [57], feasibility of delivery (1), time taken (4), and quality (3) [57]). …”

“…One trial [44] using a mobile phone to facilitate communication between nurses and surgeons reported six outcomes; one showed statistically significant benefit. Two trials [40],[43] using photos transmitted via mobile phones reported three outcomes showing negative effects of the interventions, with statistically significant reductions in fracture detection when compared to standard radiographic pictures, reductions in correct assessment of potential to perform re-implantation, and correct recognition of skin ecchymoses when compared to a gold standard assessment by a specialist evaluating ecchymoses in person.…”

Surgery nurses' telephone communication: a mixed methods study with a special focus on newcomers' calls

“…A few studies have focused on calls between hospital coworkers, investigating for instance the telephone communication of physicians (Aziz et al, 2005;Ortega, Taksali, Smart, & Baumgaertner, 2009;Soto, Chu, Goldman, Rampil, & Ruskin, 2006), among the staff of general internal medicine units (Lo, Wu, Morra, Lee, & Reeves, 2012;Whitlow, Drake, Tullmann, Hoke, & Barth, 2014;Wu et al, 2010), between floor nurses and on-call physicians (Bernstam et al, 2007) and between nurses in medical emergency centres and physicians on duty (Tjora, 2000). The majority of the existing studies revolve around safety issues related to mobile phones (Myerson & Mitchell, 2003) and their pros and cons compared with pager-mediated contact Ortega et al, 2009;Soto et al, 2006) and landline telephone use (Hanada, Fujiki, Nakakuni, & Sullivan, 2006). They also examine the usefulness of telephone communication between physicians in terms of continuity of care (Blankenship, Menapace, Fox, & Frey, 1999;Crone, 1987), ways remote and technology-mediated work communication may balance the nurse-physician professional relationship (Tjora, 2000) and the reasons for after-hours nurse-to-physician calls (Bernstam et al, 2007).…”

Smartphones as Multimodal Communication Devices to Facilitate Clinical Knowledge Processes: Randomized Controlled Trial

“…In many of the existing studies that have explored mobile clinical communication technologies, the methodological design was reported to be of lower quality and based on users’ perceptions [13]. Additionally, only a few randomized controlled experiments were identified [13,16]. …”