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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
zurĂĽck zum
Buch Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners"
Applied Interdisciplinary Theory in Health Informatics
Knowledge Base for Practitioners
- Titel
- Applied Interdisciplinary Theory in Health Informatics
- Untertitel
- Knowledge Base for Practitioners
- Autoren
- Philip Scott
- Nicolette de Keizer
- Andrew Georgiou
- Verlag
- IOS Press BV
- Ort
- Amsterdam
- Datum
- 2019
- Sprache
- englisch
- Lizenz
- CC BY-NC 4.0
- ISBN
- 978-1-61499-991-1
- Abmessungen
- 16.0 x 24.0 cm
- Seiten
- 242
- Kategorie
- Informatik