Association for Surgical Education
Smartphones let surgeons know WhatsApp: an analysis of communication in emergency surgical teams

This paper was presented at the Association for Surgical Education meeting in Chicago in April 2014 and won a Paper of Distinction Award.
https://doi.org/10.1016/j.amjsurg.2014.08.030Get rights and content

Abstract

Background

Outdated communication technologies in healthcare can place patient safety at risk. This study aimed to evaluate implementation of the WhatsApp messaging service within emergency surgical teams.

Methods

A prospective mixed-methods study was conducted in a London hospital. All emergency surgery team members (n = 40) used WhatsApp for communication for 19 weeks. The initiator and receiver of communication were compared for response times and communication types. Safety events were reported using direct quotations.

Results

More than 1,100 hours of communication pertaining to 636 patients were recorded, generating 1,495 communication events. The attending initiated the most instruction-giving communication, whereas interns asked the most clinical questions (P < .001). The resident was the speediest responder to communication compared to the intern and attending (P < .001). The participants felt that WhatsApp helped flatten the hierarchy within the team.

Conclusions

WhatsApp represents a safe, efficient communication technology. This study lays the foundations for quality improvement innovations delivered over smartphones.

Section snippets

Objectives

  • 1.

    Identify the common initiators and receivers of communication within a team.

  • 2.

    Establish the types and clinical domains of communication used through WhatsApp.

  • 3.

    Evaluate the response times to communication for different communication types, domains, and clinician grades.

  • 4.

    Explore participant's perception of WhatsApp for team communication.

Recruitment

An acute general surgery team responsible for all emergency admissions in a London (United Kingdom) teaching hospital participated in this study. The nature of the team's emergency workload involves rapid assessment, management, and discharge of all acute surgical patients. All team members were included so no sampling was required. An attending, a resident, and 2 interns rotating on a weekly basis made up the team, meaning 40 team members participated in the study. Medical students and junior

Results

A total of 1,140 hours of clinical communication pertaining to 636 patients over 95 days was recorded. This yielded 1,495 communication events (a median of 65.5 communication events per week). Of these, 359 came from the attending, 318 from the resident, 784 from the interns, and 34 from other team members. The pattern of communication from each participant over the course of the study is displayed in Fig. 1. Communication events were grouped into episodes (n = 658) and coded according to their

Principal results

This study explored the use of WhatsApp by an emergency general surgery team in London using both quantitative and qualitative methodology. This is the first study of its kind that investigates how such a communication system operates within a clinical team and quantifies both the direction and type of communication between doctors. Most communication initiated by interns was information giving or a clinical question, whereas more senior team members provided instruction-giving comments.

Conclusions

The findings of this study provide a novel and detailed examination of the communication between members of a clinical team. It meets the current need for evaluation of communication methods in healthcare.21 The WhatsApp platform was deemed to be user friendly and was extensively used to facilitate communication within a team where junior physicians rotate on a weekly basis. In addition, significant benefits were realized through a system in which senior physicians had a constant overview of

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  • Cited by (0)

    Maximilian J. Johnston, Sonal Arora, Dominic King, Nick Sevdalis, and Ara Darzi are affiliated with the Imperial Patient Safety Translational Research Centre (www.cpssq.org), which is funded by the National Institute for Health Research (40490), UK. The funders had no role in the study. The other authors declare no conflicts of interest.

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