Centre for Innovation in Complex Care, University Health Network, Toronto, Ontario, Canada.
J Am Med Inform Assoc. 2013 Jul-Aug;20(4):766-77. doi: 10.1136/amiajnl-2012-001160. Epub 2013 Jan 25.
Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness.
To describe the effects of different communication interventions and their problems.
Prospective observational case study using a mixed methods approach of quantitative and qualitative methods.
General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals.
Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards.
Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010.
We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories.
Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems.
有效的临床沟通对于提供高质量的患者护理至关重要。医院已经使用了不同类型的干预措施来改善护理团队之间的沟通，但对其效果的研究很少。
描述不同沟通干预措施及其问题。
前瞻性观察性病例研究，采用混合方法，包括定量和定性方法。
五所三级教学医院的普通内科（GIM）住院病房。
在 GIM 病房工作的临床医生，包括住院医师、主治医生、护士和辅助医疗（AH）人员。
2009 年至 2010 年期间，采用人种学方法和对临床工作人员（医生、护士、医学生和 AH 专业人员）的访谈进行了为期 16 个月的研究。
我们确定了四个类别，描述了沟通干预措施的预期和意外后果：对发送者、接收者、跨专业协作以及非正式沟通过程的使用的影响。使用字母数字寻呼机、智能手机和基于网络的通信系统对发送者和接收者都有积极的影响，但所有干预措施在所有四个类别中都存在意外后果。
旨在改善临床沟通的干预措施解决了一些问题，但并非所有问题，所有系统都存在意外影响。
