Providing mobile phones to emergency medicine residents: perceived effects on physician communication and work

Abstract

Study objectives: Effective communication in the complex emergency department (ED) environment is challenging. In the course of routine care, emergency medicine residents place and receive multiple telephone calls, many that are critical to patient decisions and care. Institutional constraints on resources may limit implementation of effective tools; in our ED, individual mobile telephones were not initially available for most emergency medicine residents. We want to evaluate the perceptions of emergency medicine residents who routinely use mobile telephones, and when additional mobile telephones are being implemented and made available to postgraduate year (PGY)-1 residents, we want to evaluate how the PGY-1 residents' perceptions changed after having routine access to a mobile telephone. Our first hypothesis is that upper-level emergency medicine residents who routinely use mobile telephones perceive improved work habits, efficiency, and satisfaction. Second, we hypothesize that after implementing expanded mobile telephone access for PGY-1 residents and surveying before and after, there will be perceived improvement in the same measures. Methods: This study was at an urban academic Level I ED with annual visits of 90,000 patients. The emergency medicine residency is a 3-year program with 30 residents. Before the study, there were approximately 20 mobile telephones in use in the ED, reserved for emergency medicine attending physicians, some upper-level emergency medicine residents, and other key support staff. The survey consisted of 12 questions, 7 with percentile responses and 5 with Likert scale (0 to 6) satisfaction/agreement scores. Part 1 of the study was conducted in December 2003, with a survey of upper-level emergency medicine residents. Part 2 of the study was the same survey, administered before and after to PGY-1 emergency medicine residents after additional mobile telephones were implemented (December 2003) and after PGY-1 residents had access for at least 2 months. Data were analyzed using dependent t tests. Results: Part 1 surveys were completed by 18 upper-level emergency medicine residents (90%). Upper-level emergency medicine residents reported access to a mobile telephone during 76.9% of their shifts (95% confidence interval [CI] 63.0% to 90.9%). They perceived missing return calls 11.0% of the time (95% CI 6.0% to 16.1%) and reported waiting around the central working area for a return page about 23.2% of the time (95% CI 9.5% to 36.9%). Regarding use of the mobile telephone, the upper-level residents preferred to call the page operator to place a page, rather than use a posted numeric code system (57.0% versus 33.4%, 95% CI −3.6% to 50.8%). They were satisfied with the current telephone system, with an average satisfaction scale of 4.4 (0 to 6 scale; 95% CI 3.8 to 5.0). Likewise, they strongly perceived that routine use of a mobile telephone would increase their efficiency (5.5 on a 0 to 6 scale; 95% CI 5.1 to 5.9), improve patient care (5.4 on a 0 to 6 scale; 95% CI 4.9 to 6.0), and allow being located easily (5.8 on a 0 to 6 scale; 95% CI 5.5 to 6.0). Part 2 before-and-after surveys were completed by 9 PGY-1 residents (90%). As a measure of implementation, PGY-1 residents reported increased access to a mobile telephone from an average of 2.3% to 91.6% of their shifts (89.3% increase, 95% CI 99.4% to 79.2%). All reported a decrease in perceived missed return calls from an average of 20.3% to 4.6% (15.7% decrease, 95% CI −0.2% to −31.2%), as well as less waiting around the central working area for a return page from an average of 67.8% to 13.9% (53.9% decrease; 95% CI −32.0% to −75.8%). With regard to their telephone usage, there was no significant change in the use of 3 paging systems. After implementation of the mobile telephones, all PGY-1 residents reported an increase in satisfaction with the telephone system from an average of 2.4 to 4.1 (0 to 6 scale, 1.7 increase; 95% CI 0.0 to 3.5). They all believed as well that routine use of a mobile telephone would increase their efficiency, improve patient care, and allow being located easily. That perception remained unchanged after distribution of the mobile telephones. Conclusion: Providing a personal mobile telephone to emergency medicine residents improves perceived work habits, efficiency, and satisfaction. Resources need to be available to provide tools for emergency medicine residents and other physicians to provide high-quality patient care in the challenging and demanding ED environment.