Technology Based Challenges of Informal Clinical Communication in an Australian tertiary referral hospital – A mixed methods assessment of The Need for Change

Abstract

BackgroundEffective communication is critical for safe, efficient clinical practice. Communication failures result in errors, misdiagnosis, inappropriate treatment and poor care. Communication errors also contribute to sentinel events and are an underlying factor in healthcare system complaints.Formal Clinical Communication (FCC) tools, such as ISBAR, improve patient outcomes. Governance of FCC is increasingly based around Electronic Medical Record (EMR), however much Informal clinical communication (ICC) occurs outside of the EMR.ICC involves disparate platforms including pagers, Short Message Service (SMS) texts, encrypted messaging apps, phones and local radio networks (eg Vocera). Documentation of ICC in the clinical record is low quality and not easily or routinely audited. ICC based on personal identities relies on accurate rosters, switchboard staff or secondary lists. Significant inefficiency and potential clinical risk can occur if the correct role to communicate with cannot be contacted quickly and easily.Local ProblemIn 2019, Austin Health performed a clinical governance assessment of ICC processes against National Standards for FCC. Further investigation and process mapping of ICC occurred in 2020. This indicated a paucity of relevant policy and procedures to govern ICC practices, with highly variable and overly complex processes.AimsTo document the technology used in informal communication between clinical and / or administrative staff.To document the self-perceived impact on staff of current communications methods.To document the self-perceived potential efficiency and safety impact of current communications methods.To identify key factors for consideration in organisational informal communication improvement.MethodMulti-disciplinary on-line staff cross-sectional survey using Microsoft Forms. The survey sought to confirm the range of informal communication methods in use and identify respondents’ perceptions of current multimodal communication technology issues and their inherent risks.Results115 self-selected clinical and administrative staff completed the survey. Multiple communication channels are used. Respondents noted high levels of frustration, delay, interruption and inefficiency. Desired communication improvements and use considerations were identified. Survey findings validated a prior clinical governance assessment of the existing ICC framework, and the need for technology reform.ConclusionsThere are gaps in governance standards for ICC, both locally and at a broader level. Sequential additions to technology platforms have created a high-risk communications environment. Staff perceptions of inefficiency, delay, frustration and a high level of patient safety risk were consistent across professions. This work informed the subsequent development of an enterprise platform dedicated to informal clinical communication.Key Message Summary BoxWhat is already known on this topic– Poor Communication practice contributes to preventable errors or adverse events in patient care. Use of structured handover tools such as ISBAR provide a framework to improve Formal Clinical Communication. Current multi-modal, communication technologies for Informal Clinical Communication are interruptive, inefficient, compound staff frustration and create potential for patient harm.What this study adds– We describe staff impressions of frustration, time wasting and potential for patient harm with existing multi-modal communications technologies together with a framework for informal communication policy enhancement.How this study might affect research, practice or policy– These findings provide a call for governance standards for informal clinical communication. We highlight the need for rationalisation of multi-modal communications technologies to reduce communication complexity and identify some key functional requirements for new technologies.