International Journal of Advanced Joint Reconstruction 2015; 2(1): 23-26.
ORIGINAL
ISSN 2385 - 7900
Whatsapp messenger for surgical team coordination.
Initial experience of a hip team in a third level hospital.
Jenaro A. Fernández-Valencia 1, Elena Salas 2, Jorge Egea 3, Maria Cinta Pinyol 2,
Montserrat Orench 2,Montserrat Tió 4, Montserrat Díaz 2, Guillem Bori 1, Xavier Gallart 1.
1) Department of Orthopaedic and Trauma Surgery. Hospital Clínic. University of Barcelona, Spain and
2) Nursery at Surgical Area 4.1. Hospital Clínic. University of Barcelona, Spain
3) Student of Medicine at the Faculty of Medicine, University of Barcelona, Spain
4) Department of Anesthesiology. Hospital Clínic. University of Barcelona, Spain
Copyright © 2015 J. Fernández-Valencia et al. This is an open access article distributed under the Creative Commons Attribution
.
License, which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work is properly cited.
Received: 28 March 2015/ Accepted 15 April 2015 / Published online 4 June 2015
ABSTRACT
Background/Aims: The use of instant messaging has emerged in our work as surgeons. Incorporated now as a routine tool, we aimed
to evaluate its use in aiding to coordinate a team of orthopedic surgeons, nurses and anesthesiologists focused on hip surgery.
Methods: A retrospective was conducted, reviewing the number of messages performed using WhatsApp Messenger, and also
evaluating its content from 1 April 2013 to 31 December 2013. Number of messages were differentiated regarding age, and the app use
was evaluated comparing users over and under 45 years-old. Any interference with medical devices in the operating room was
registered.
Results: 890 posts in 177 conversations were performed during the specified period of time. Most of the conversations were caused to
talk about the prosthetic materials or about operating room occupancy. No differences were observed regarding age of the user. No
interference with medical devices in the operating room was registered.
Conclusions: Instant messaging can be used as a valuable tool in order to coordinate surgical teams. We consider this as a valuable
approach in order to streamline the communication between members. We consider that future development of specific apps to improve
communication between health professionals is granted.
KEYWORDS
Hip, Instant messaging, WhatsApp, medical App, surgical team, coordination, mHealth.
Correspondence:
Dr. Jenaro A. Fernández-Valencia
Orthopaedic Surgeon.
Department of Orthopaedic and Trauma Surgery
Hospital Clinic, Barcelona Spain.
Villarroel, 170 – 08036 Barcelona Spain.
Telephone number: (+34)932275533
E-mail: [email protected]
Conflict of interest statement The authors declare
that they have no conflict of interest related to the
publication of this manuscript
How to cite this article
Fernández-Valencia JA, Egea J, Pinyol MC, Orench M,
Salas E, Gallart X. Whatsapp Messenger for Team
Coordination in Surgical Areas. Initial Experience of a
Hip Team in a Third Level Hospital. Int J Adv Jt.
Reconstr. 2015; 2(1): 23-25.
INTRODUCTION
Communication and collaboration is essential for a
surgical team in order to minimize errors in the treatment of
patients, and to provide the best results.
Coordination includes to prepare everything for the
specific patient, to coordinate the order of the patients and to
achieve full participation of the whole team for every detail of
each procedure. Common issues are regarding the type of
implant to be used, usual instruments necessary or specially
demanded for the case, and specific medical issues for each
patient that must be taken into account. Usual means to
achieve it include the use of telephones, organizational
meetings, emailing, debriefing previously to the surgery, and
checklists also before the procedure, but there is always a need
to improve communication. [1-2] Introducing instant
messaging raises the possibility of improving
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International Journal of Advanced Joint Reconstruction 2015; 2(1): 23-26.
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communication of the members in the surgical area both while
preparing surgeries for the forthcoming days, as well for the
surgeries prepared for the same day.
In the present study we show our initial experience in the
use of instant messaging (IM) as an adjunct to traditional
systems.
METHODS
In April 2013 the Hip Unit at the Hospital Clinic
(University Hospital, third level) created a WhatsApp® group
named “Maluc Team OR” including all health professionals
involved in the surgical treatment of the patients. The
recruitment for the group was not forced, and members were
allowed to maintain in the group if they found it useful or to
leave the group if they didn´t want to stay. Members used
different smartphones, and both Whatsapp Messenger for
android and for iPhone was used as updated by April 2013.
Languages used for messaging were spanish and catalan as
preferred by users (Fig.1).
The program for each week was discussed on Mondays in
a first hour session, including the time of surgery to be
performed, the type of implants to be used and the time
required. Members at this session are the orthopedic surgeons
at the hip unit,
orthopedic residents, and the patient
coordinator. Once the list was confirmed, the patient
coordinator contacted the patients and confirmed the program
on Thursdays by email attaching and excel file including all
the data. The Whatssapp group was created as an aid to ease
communication between members after the reception of this
file for any purpose related to each surgery.
A group coordinator was designated (JFV), being
responsible for the incorporation of new members, and to
moderate the conversations if required. At all times, the
explicit use of the names or images of patients was avoided.
Any reference to a specific procedure for a patient was
commented referring to the case as the number of order and
day of the week as scheduled in the excel planning sent by the
patient coordinator. The group included a total of 15
professionals.
Figure 2: Collage of some of the pictures sent to the group
Eight months after the introduction, all the posts performed
were downloaded (as WhatsApp allows this option) and
reviewed. We evaluated which professionals made greater use
based on age (comparing members under vs over 45 yearsold), and analyzed what was the reason for the conversations
(studied period: 1/4/2013 to 31/12/2013). The topic of
conversations was classified according to the following
categories: 1) Operating room occupancy; 2) Schedule; 3)
Prosthetic Material; 4) Patient´s clinical issues; 5) Surgical
Information; 6) Miscellaneous.
On the other hand, some of the messages were performed
in the surgical area or even in the operating room. We
registered any interference with medical devices, taking into
account the recommendation to restrict mobile phone use to
greater than 1 meter from equipment. [3]
RESULTS
A total of 890 posts were made, 60 of which were excluded
from the analysis because they were messages of support or
withdrawal from the group, as well as initial tests. It gave us a
total of 830 messages, grouped in 177 conversations.
Two surgeons left initially the group, but re-joined shortly
after. They argued that at the beginning they were
overwhelmed by the excessive messages. However, after
Figure 1: Example of one of the conversations
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regulation of the content by the administrator, they found
useful to re-join the group.
The reasons for conversation were 1) Prosthetic Material
(48 conversations, 27.1%) and 2) Operating room occupancy
(47 conversations, 26.5 %) and 3) Schedule ( 21
conversations, 11.8%). Issues such as the time of entry of the
patient or startup time for surgery were included in the
operating room occupancy. The Prosthetic Material
conversations mainly were about special needs of implants or
the confirmation of reception of material (different than the
available in the hospital stock). Surgical Information
represented 18 conversations and patient´s clinical issues 6
conversations. Some examples of the pictures included in the
messages is shown in Fig. 2.
In the Miscellaneous section we found unexpectedly 1)
social group messages (29 conversations), 2) scientific articles
of interest with link (6 conversations) and 3) sessions of
interest to the team (2 conversations).
There were no significant differences in the use of instant
messaging based on age (p < 0.05).
We did not observe any interference with medical devices
in the operating room.
DISCUSSION
Previous reports about the use of IM for medical or
surgical teams is scant but growing. Wani et al performed a
similar study as the reported in the present article, aiming to
assess the efficacy of WhatsApp as a communication method
amongst the staff of plastic and reconstructive surgery, used
for various aspects of patient management and as a tool for
academic endorsements. [4] They analyzed 116 episodes
regarding patient management. In addition opinion of rotating
residents in the section was sought regarding the efficacy of
this method of communication. They report that overall
majority of residents were satisfied with this mode of
communication. At our unit, we have incorporated rotating
residents in the WhatsApp group after they asked for it, in
order to share information among all the participating health
professionals. It can be also valuable as a teaching tool, as it
exemplifies the planning necessary to prepare each surgical
program and the common problems encountered.
Johnston et al provided results about WhatsApp use in and
emergency surgery team (40 members). [5] They evaluated
response times and communication types. 1,495
communication events were evaluated. They observed that the
attending initiated the most instruction-giving communication,
whereas interns asked the most clinical questions (P < 0.001).
The resident was the speediest responder to communication
compared to the intern and attending (P < 0.001). In this study,
the participants felt that WhatsApp helped flatten the hierarchy
within the team.
Giordano et al obtained plain radiographs and CT scans
from 13 cases of tibial plateau fractures and sent them to six
observers via the WhatsApp Messenger application in order to
determine the standard deviation and type of injury, the
classification according to the Schatzker and the Luo
classifications schemes, and whether the CT scan changed the
classification. [6] The inter- and intra-observer agreement
ranged from excellent to perfect (0.75<κ<1.0) across all
survey questions. They propose the systematic use of the
application to facilitate faster documentation and obtaining the
opinion of an experienced consultant when not on call.
Regarding the possible interference with medical devices
in the operating room, it never occurred in the present study.
Some anecdotal reports have been published, interfering with
medical devices at operating rooms or intensive care units.
The use of mobiles has been reported to interfere mainly with
cardiac monitors or with pacemakers. [7] However, in the case
of the interference with the pacemaker, it occurred with the
mobile phone at a distance of up to 10 cm from the equipment.
[8] Probably, newer generation mobile phones might be used
much closer to equipment than their predecessors but we
adhere to observe still the recommendation to restrict mobile
phone use to greater than 1 meter from the equipment.
We consider that it is necessary to regulate the use for each
group, and the administrator has to assume this role, specially
taking care for the appropriate use of this channel of
communication.
This study has several limitations. Our main purpose was
to evaluate our initial experience and it lacks of details such as
the time taken to perform the responses when a question was
done or the degree of satisfaction of the users. However, it is
noticeable that this group is still active on May 2015, and has
increased its members to 25 participants.
In conclusion, our experience in the introduction of IM has
been favorable. The talks dealt most frequently about
prosthetic material and operating room occupancy, with a
resolution of the issues through the messaging system itself.
Since there were no differences in the use regarding age
group, and because its use is now consolidated after two years
of use, we believe that the incorporation of IM can be
generalized to optimize patient care in surgical areas. We
consider that future development of specific apps to improve
communication between health professionals is granted.
REFERENCES
1.
France D, Leming-Lee S, Jackson T, Feistritzer NR, Higgins MS. An
observational analysis of surgical team compliance with perioperative
safety practices after crew resource management training. American
Journal of Surgery 2008; 195(4): 546–553.
2.
Ren Y, Kiesler S, Fussell SR. Multiple Group Coordination in Complex
and Dynamic Task Environments: Interruptions, Coping Mechanisms,
and Technology Recommendations. Journal of Management Information
Systems 2008; 25(1): 105-130.
Fernández-Valencia JA et al. Whatsapp Messenger for Surgical Team Coordination.
This and more Open Access and Peer Reviewed publications at www.healthyjoints.eu/IJAJR
!325
International Journal of Advanced Joint Reconstruction 2015; 2(1): 23-26.
ORIGINAL
ISSN 2385 - 7900
3.
Irnich WE, Tobisch R. Mobile phones in hospitals. Biomed Instrum
Technol. 1999;33:28–34.
4.
Wani SA, Rabah SM, Alfadil S, Dewanjee N, Najmi Y. Efficacy of
communication amongst staff members at plastic and reconstructive
surgery section using smartphone and mobile WhatsApp. Indian J Plast
Surg. 2013 Sep;46(3):502-5.
5.
Johnston MJ, King D, Arora S, Behar N, Athanasiou T, Sevdalis N,
Darzi A. Smartphones let surgeons know WhatsApp: an analysis of
communication in emergency surgical teams. Am J Surg. 2015;209(1):
45-51.
6.
Giordano V, Koch HA, Mendes CH, Bergamin A, de Souza FS, do
Amaral NP. WhatsApp Messenger is useful and reproducible in the
assessment of tibial plateau fractures: inter- and intra-observer
agreement study. Int J Med Inform. 2015;84(2):141-8.
7.
Saraf S. Use of mobile phone in operating room. J Med Phys.
2009;34(2):101-2.
8.
Naegeli B, Osswald S, Deola M, Burkart F. Intermittent pacemaker
dysfunction caused by digital mobile telephones. J Am Coll Cardiol.
1996;27:1471–7.
Fernández-Valencia JA et al. Whatsapp Messenger for Surgical Team Coordination.
This and more Open Access and Peer Reviewed publications at www.healthyjoints.eu/IJAJR
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