24 Journal for Healthcare Quality Wireless Communication in Clinical Environments with Unique Needs Rosemary Wilson, Lenora Duhn, Paola Gonzalez, Susan Hall, Yolande E. Chan, Elizabeth G. VanDenKerkhof Abstract: Wireless technology in healthcare has been associated with communication-related improvements in workflow; how- ever, there are barriers to adoption. This study examined predic- tors of use of wireless communication devices (WCDs) in environ- ments with unique needs (i.e., intensive care unit [ICU]). Nurses were recruited in the ICU to complete a paper questionnaire to assess their willingness to use WCDs. The Theory of Planned Be- haviour was used to assess attitudes, subjective norms, perceived control, and behavioral intent. Responses included Likert scale scores and open-ended questions. Data were collected before and following the implementation of WCDs in ICU. The combined ef- fects of attitudes, perceived control and subjective norms on be- havioral intent were tested using the general linear model. The narrative data were analyzed using a thematic analysis approach. Attitudes and subjective norms were predictors of behavioral in- tent to use WCDs preimplementation but not postimplementation. Differences in the factors affecting intent to use WCDs between the ICU and the surgical unit may be related to the unique nature of the critical care environment, and to the lack of a comprehen- sive preimplementation strategy. A study examining predictors of use on a general inpatient unit where a comprehensive imple- mentation strategy was not employed would provide insight into whether these findings are related to the implementation strategy or the unique nature of the critical care environment. Improved understanding of the function and application of innovative tech- nology at the point of care, and attention to the process of im- plementation may improve adoption of this potentially beneficial device. Keywords academic acute communication critical care research evaluation Effective communication is defined in engi- neering terms as the accurate and unbroken transmission of information that results in un- derstanding (Feldman, & March, 1981; Stohl & Redding, 1987) and therefore improves work- flow. Effective communication processes de- crease nonvalue added activities for nurses, such as looking for others to assist with pa- tient care, missed telephone calls, and seeking devices (VanDenKerkhof et al., 2009). Com- munication not only affects workload, but it also affects the safety and quality of care. Communication breakdown has been identi- fied as the leading cause of in-patient mor- tality, even exceeding mortality due to inad- equate skill (Wilson et al., 1995). The Joint Commission on Health Care Accreditation in the United States promoted the need to im- prove the coordination and effectiveness of communication among healthcare providers (The Joint Commission, 2007). This need was also identified by the Canada Health Council in a report entitled, “Progress Report 2012: Health Care Renewal in Canada” (Health Council of Canada, 2012). Communication among nurs- ing staff is an essential part of safe and ef- fective care. Clinical environments are fraught with inefficiencies, distractions, and nonvalue added activities that have a potential impact on health outcomes for patients. The Institute of Medicine has encouraged the development of consistent and robust information sharing methods and the reduction of activities associ- ated with locating supplies, looking for person- nel, and working around inadequate commu- nication systems (Baumann et al., 2001). In intensive care environments, establishing effective communication and care coordina- tion is critical to improve quality and safety in patient care (Reader, Flin, Lauche, & Cuthbert- son, 2006). The quality of interdisciplinary com- munication in intensive care unit (ICU) settings has been examined (Reader, Flin, Mearns, & Cuthbertson, 2007b) and identified as a mitigat- ing factor in critical incidents (Reader, Flin, & Cuthbertson, 2007a). The authors of a system- atic review of ICU team performance identified team communication and coordination as pro- cesses affecting patient outcomes (Reader, Flin, Mearns, & Cuthbertson, 2009). Technology has a role to play in enhancing communication processes. A voice-controlled technology that allows instant and hands-free communication is one form of wireless commu- nication technology being promoted. Research indicates that the adoption of wireless com- munication devices (WCDs) in healthcare set- tings has improved communication and work- flow process, in particular for nurses. Van- DenKerkhof and colleagues (2009) reported that nurses and unit clerks reported the time used for key communication activities was re- duced by 25% overall, looking for others was reduced by 45%, and looking for assistance was reduced by 54% after the implementation of a WCD in a general surgical adult patient unit in Journal for Healthcare Quality Vol. 36, No. 6, pp. 24–32 C  2013 National Association for Healthcare Quality