How Technology Can Improve Junior Doctor Communication about the Deteriorating Patient

Abstract

Objective: In this research, I aimed to improve communication to and from junior doctors managing deteriorating hospital patients. Communication can sometimes be delayed and incomplete, contributing to avoidable patient morbidity and mortality. Information and communication technologies (ICTs) are already used for general work by junior doctors, but could be improved in this clinical context. More knowledge about two themes was required: (1) junior doctor communication and (2) what junior doctors want in a ward clinical ICT system when managing deteriorating patients. Methodology and research design: This research was conducted from an interpretivist and pragmatist perspective, aiming to develop theory about the two themes. Action research was the overarching methodology because of the intention to improve organisational communication and patient care. Five action research cycles formed a cyclical and spiral process. Semi-structured interviews were the primary data collection method, augmented by experimental vignette methodology. The vignettes were derived from deteriorating ward patient cases. Observation, questionnaires and ICT message analysis were also used. Classical grounded theory was used to analyse the data collected and to develop a substantive theory. Qualitative content analysis was used specifically for the analysis of data arising from the vignettes and ICT system message content. Results: Action research cycles one, four and five addressed theme one. Junior doctors interpreted messages about deteriorating ward patients through the lens of risk. Clinical experience, efficiency in clinical work and perceived responsibility to the patient and other doctors influenced junior doctor interpretation of risk to patients and themselves. These factors also affected whether junior doctors communicated further to other clinicians. Doctors valued the content and quality of communication; however, content was not necessarily synonymous with quality. Action research cycles two, three and five addressed theme two. Nurse–junior doctor clinical ICT systems were studied. Consistent findings were that junior doctors found ICT system reliability and efficiency to be the most important features. ICT reliability represented the likelihood that messages sent would be promptly received by the correct recipient. ICT efficiency was the perceived amount of time that a junior doctor had to expend reading, organising and sending communications. Junior doctors preferred mobile ICT devices but did not insist on them, provided that task information was easily accessible. Their preference was influenced by the context of usage. Although junior doctors stated a preference for synchronous communication when discussing deteriorating patients, this was not borne out by ICT message analysis findings. Discussion and conclusion: A substantive theory was developed, situated within the communication process about deteriorating ward patients. It explains interpretation of messages from nurses to junior doctors, and decisions about communication to other doctors. Another substantive theory was developed explaining the features required in nurse–junior doctor ICT systems to convey such communication. These theories were then integrated so that the result could be used to guide clinical ICT system design to improve junior doctor communication about the deteriorating ward patient. The results also show that hospital clinician communication about the deteriorating ward patient represents a complex adaptive system. The implications of the integrated theory for development and implementation of future contextual ICT systems are discussed.