1. Breaking Barriers to
Effective In-Hospital
Communication
Omar Metwally, MD
St. Mary’s Medical Center Grand Rounds
October 8th 2015

2. Disclosure
● I have no conflicts of interest to disclose
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3. Goals
● Illustrate problematic in-hospital communication with three cases
● Present advantages and disadvantages of communication tools currently
used at St. Mary’s
● Review literature on in-hospital communication systems
● Provide a glimpse into solutions
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4. ● 30 yoM with DM2 complicated by osteomyelitis s/p toe amputations,
diabetic nephropathy, CKD III and systolic heart failure who was
transferred from St. Francis for podiatry care
● Initial plan for 48 hrs of ongoing vancomycin for MRSA osteomyelitis s/p
transmetatarsal amputation per PROS recommendations
● Outside records were ambiguous
○ Baseline Cr of 2.3? vs Cr 1.8 on admission
○ Creatinine was 2.5 with K 5.8 on hospital day 2
● Vancomycin trough checked on HD 2: 58.7; suspended on HD 4
● Hemodialysis started on HD 5
Case 1: Mr. μ
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5. What’s wrong with this picture?
Source: Highlights Kids
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6. Case 2: Ms. τ
● Healthy 83 yoF admitted with R hand swelling & pain
● Orthopedic surgery attempted to aspirate R wrist in ED
unsuccessfully
● This was communicated by night team during sign out
● Day team discharged her on antibiotics for cellulitis
● Orthopedic surgery contacted Medicine recommending that
patient remain in hospital to work up septic arthritis
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7. What’s wrong with this picture?
Source: Highlights Kids
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8. Case 3: Ms. Σ
● 66 yoF with CAD s/p CABG and multiple stents, DM2, chronic
lymphedema and LE ulcers, directly admitted by PROS
● PROS requested that medicine assume primary
responsibility for patient
● Patient was on the floor for hours without any paper or
electronic records
● No attending to attending or resident to resident sign out
● No medication list available
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10. Survey Prompt #1
Examples where technology helps you communicate with
colleagues
Examples where technology hinders your ability to
communicate effectively
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11. Survey Prompt #2
What do you think of the current paging system?
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12. Survey Prompt #3
What do you think of Medisas?
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13. Survey Prompt #4
What is the biggest communication-related problem we
have at St. Mary’s?
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25. An Evaluation of the Use of Smartphones to
Communicate Between Clinicians: A Mixed-
Methods Study
J Med Internet Res. 2011 Jul-Sep; 13(3): e59.
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29. Future Directions
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30. Take-Home Points
● First do no harm
● Technology is used inconsistently within a hospital
● Organizational programming is at least as
important as the techology!
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31. Thank you!
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32. References
1. Przybylo JA et al. Smarter hospital communication: secure smartphone text messaging improves provider
satisfaction and perception of efficacy, workflow. J Hosp Med. 2014 Sep;9(9):573-8.
2. Sehgal NL et al. Patient whiteboards as a communication tool in the hospital setting: a survey of practices and
recommendations. J Hosp Med. 2010 Apr;5(4):234-9.
3. The consequences of poor communication during transitions from hospital to skilled nursing facility: a
qualitative study. J Am Geriatr Soc. 2013 Jul;61(7):1095-102. King BJ1, Gilmore-Bykovskyi AL, Roiland RA,
Polnaszek BE, Bowers BJ, Kind AJ.
4. Ighani F et al. A comparison of two-way text versus conventional paging systems in an academic ophthalmology
department. J Med Syst. 2010 Aug;34(4):677-84.
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33. 5. Wu RC et al. Effects of clinical communication interventions in hospitals: a systematic review of information and
communication technology adoptions for improved communication between clinicians. Int J Med Inform. 2012
Nov;81(11):723-32.
6. Nguyen C et al. The use of technology for urgent clinician to clinician communications: a systematic review of the
literature. Int J Med Inform. 2015 Feb;84(2):101-10.
7. McElroy LM et al. The role of technology in clinician-to-clinician communication. BMJ Qual Saf. 2013 Dec;22
(12):981-3.
8. Wu R et al. An evaluation of the use of smartphones to communicate between clinicians: a mixed-methods
study. J Med Internet Res. 2011 Aug 29;13(3):e59.
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