Page - 130 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

as either reading the Hark message or calling the locator page number. Further communication from the junior doctors to any other clinician was not studied. Participant communication was assessed by the Quality of Information Transfer (QUIT) tool and participation satisfaction was assessed by survey. Message receipt speed was no different between Hark and locators, although the former was thought to have better information transfer quality and overall ICT system efficiency. Participants did not prefer Hark to locators as a primary system for ward nurse to doctor communication. This is surprising, given junior doctors often prefer mobile phones [23]. DCMT provides another lens by which to interpret and explain Patel et al’s [34] findings, via ICT efficiency as in Figure 1. Hark and locators had similar ICT reliability in that both sent messages equally fast, although Hark was thought to have fewer errors. Hark facilitated ICT efficiency in terms of prioritisation features, information storage and transfer, acting as a communication record, facilitating collaboration and minimising interruption. However, Hark did not offer improvement in other aspects of ICT efficiency. The two ICT systems were equivalent with regard to sufficient communication detail, ease of use and the ease of contacting other clinicians. Hark messages did not indicate which senior doctor was responsible for the patients care and thus the recipient junior doctor would not have known which other team doctors to communicate to. Findings equivalent to two other DCMT factors contributing to ICT efficiency were also equivocal. The exact nature of ICT accessibility was not stated. Although junior doctors might first receive urgent messages asynchronously, they usually prefer synchronous communication for urgent issues [23]. It is not clear which ICT system mode would be used, i.e. whether Hark mobiles permitted telephony [34] and thus its accessibility. Hark did allow for a reply to the original question but did not appear to facilitate discussion beyond this, i.e. it lacked full ICT bi-directionality. The cumulative effect would be that although Hark was partially better than locators, it was not clearly superior in ICT reliability or efficiency. This may be why participants did not prefer Hark as a primary ICT system [34], and suggests how Hark could be improved. Kelly et al’s [36] paper will be used to demonstrate how DCMT can explain junior doctor interpretation and response to communication about the deteriorating patient, as Patel et al [34] focused on ICT evaluation. Kelly et al [36] surveyed junior doctors in one hospital regarding barriers and enablers to deteriorating patient escalation. The major barriers would be classified under DCMT into responsibility identification, experience at communication, assessment and patient management, and risk. Risk was that associated with determining which patients needed to be escalated and the response of senior doctors. Kelly et al.’s [36] participants also thought that risk judgment could be impaired by contextual factors e.g. competing demands. In DCMT, risk is an interpretation by junior doctors receiving information rather than an absolute and objective representation of a patient’s risk of deterioration. Consequently, improving adverse contextual factors may not decrease escalation. Concurrent high workload, by decreasing time available for patient care, may increase perceived patient risk and thus favour escalation. Kelly et al.’s participants [36] suggested countering communication barriers by improving junior doctor training and organisational culture e.g. senior doctor accessibility. ICT improvement was also suggested as a minor factor. In practice, these changes may be complex to achieve [11], let alone to any consistent degree between different hospitals [36]. DCMT analysis of Kelly et al.’s [36] major escalation barriers suggests other targets for improvement. Clarification of communication participants and task responsibility is important for all health ICT systems and especially so for the treatment of deteriorating J.Liangetal. / JuniorDoctorCommunicationSystemsand theDCMT130