• Robert C Wu, Vivian Lo, Dante Morra, Brian M Wong, Robert Sargeant, Ken Locke, Rodrigo Cavalcanti, Sherman D Quan, Peter Rossos, Kim Tran, and Mark Cheung.
• Centre for Innovation in Complex Care, University Health Network, Toronto, Ontario, Canada. Robert.Wu@uhn.ca
• J Am Med Inform Assoc. 2013 Jul 1; 20 (4): 766-77.

BackgroundEffective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness.ObjectivesTo describe the effects of different communication interventions and their problems.DesignProspective observational case study using a mixed methods approach of quantitative and qualitative methods.SettingGeneral internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals.ParticipantsClinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards.MethodsEthnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010.ResultsWe identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories.ConclusionsInterventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems.

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