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BackgroundChanges in the medium of communication from paging to mobile secure text messaging may change clinical care, but the effects of these changes on patient outcomes have not been well examined.ObjectiveTo evaluate the association between inpatient medicine service adoption of mobile secure text messaging and patient length of stay and readmissions.DesignObservational study.ParticipantsPatients admitted to medicine services at the Hospital of the University of Pennsylvania (intervention site; n = 8995 admissions of 6484 patients) and Penn Presbyterian Medical Center (control site; n = 6799 admissions of 4977 patients) between May 1, 2012, and April 30, 2014.InterventionMobile secure text messaging.Main MeasuresChange in length of stay and 30-day readmissions, comparing patients at the intervention site to the control site before (May 1, 2012 to April 30, 2013) and after (May 1, 2013 to April 30, 2014) the intervention, adjusting for time trends and patient demographics, comorbidities, insurance, and disposition.Key ResultsDuring the pre-intervention period, the mean length of stay ranged from 4.0 to 5.0 days at the control site and from 5.2 to 6.7 days at the intervention site, but trends were similar. In the first month after the intervention, the mean length of stay was unchanged at the control site (4.7 to 4.7 days) but declined at the intervention site (6.0 to 5.4 days). Trends were mostly similar during the rest of the post-intervention period, ranging from 4.4 to 5.6 days at the control site and from 5.4 to 6.5 days at the intervention site. Readmission rates varied significantly within sites before and after the intervention, but overall trends were similar. In adjusted analyses, there was a significant decrease in length of stay for the intervention site relative to the control site during the post-intervention period compared to the pre-intervention period (−0.77 days ; 95 % CI, −1.14, −0.40; P < 0.001). There was no significant difference in the odds of readmission (OR, 0.97; 95 % CI: 0.81, 1.17; P = 0.77). These findings were supported by multiple sensitivity analyses.ConclusionsCompared to a control group over time, hospitalized medical patients on inpatient services whose care providers and staff were offered mobile secure text messaging showed a relative decrease in length of stay and no change in readmissions.

Objective This report describes a root cause analysis of incorrect provider assignments and a standardized workflow developed to improve the clarity and accuracy of provider assignments. Materials and Methods A multidisciplinary working group involving housestaff was assembled. Key drivers were identified using value stream mapping and fishbone analysis. A report was developed to allow for the analysis of correct provider assignments. A standardized workflow was created and piloted with a single service line. Pre- and post-pilot surveys were administered to nursing staff and participating housestaff on the unit. Results Four key drivers were identified. A standardized workflow was created with an exclusive treatment team role in Epic held by a single provider at any given time, with a corresponding patient list column displaying provider information for each patient. Pre- and post-survey responses report decreased confusion, decreased provider identification errors, and increased user satisfaction among RNs and residents with sustained uptake over time. Conclusion This work demonstrates structured root cause analysis, notably engaging housestaff, to develop a standardized workflow for an understudied and growing problem. The development of tools and strategies to address the widespread burdens resulting from clinical communication failures is needed. Lay Summary Care of a hospitalized patient involves coordinating care between many members of an interdisciplinary team. Secure text messaging applications are emerging as a way to facilitate communication between different team members. These applications are joining complex ecosystems of existing communication workflows. With multiple communication modalities, increasing shift based work, and multiple providers on a team, it is increasingly confusing to know who to reach out to for concerns about patient care or requests for orders for patients. Providers want workflows that minimize disruptions and other members of the care team want to minimize the energy spent trying to find the right person to contact. We describe the state of this problem at our institution and report a deep root cause analysis conducted with a multidisciplinary team of resident physicians and nursing innovation leaders to develop a streamlined workflow to make it obvious who the responsible provider is for any given patient. We demonstrate perceived improvements in ease and fidelity of contacting the correct provider and improvement in overall satisfaction with the workflow.

Background: To improve communication between clinical providers and the laboratory, we recently implemented secure text messaging for our critical value notifications. This was done to communicate laboratory critical values (CV) to providers faster so changes to patient care could be done faster. Our previous method of communicating CV to providers was paging and relied on a call back to receive the critical value. Methods: We implemented delivery of CV through a secure texting application in which the CV was directly communicated to the provider on their smart phone device. Results: The mean pre-implementation turnaround time (TAT) was 11.3 minutes (median: 7 minutes, range: 0 - 210 minutes). The mean post- secure text messaging implementation TAT was 3.03 minutes (median: 0.89 minutes, range: < 1 - 95 minutes).When comparing pre- and post-implementation, there was a significant reduction in the TAT from using secure text messaging (p < 0.001). Of the 234 surveys sent out, 81 providers responded (35%). Of these responses, 85% reported that critical value notification by secure text messaging has increased their efficiency and 95% reported that critical value notification is more effective than a pager-phone-call based system. 83% of providers reported that they were able to provide better, faster care to their patients. Conclusions: Using secure text messaging (STM) to deliver critical values significantly reduces the CV TAT. Furthermore, providers noted they preferred to receive CV notifications through STM and reported that they were able to provide more effective care to their patients.

Hospital-at-home (HaH) care models are increasingly being adopted as a strategy to treat older adults with acute care needs and reduce strain on health care systems. Technological innovations, particularly digital communication platforms, have become essential in enabling care delivery beyond traditional hospital settings. Among these, asynchronous messaging tools have the potential to facilitate safe, timely, and coordinated interactions between health care providers, patients, and caregivers. Despite growing interest, little is known about how the content and relational dynamics of such exchanges influence care experiences in real-world HaH contexts. This study aimed to examine the content of SMS text messaging exchanged between health care providers and patients or caregivers within a HaH program in Singapore during the COVID-19 pandemic. A descriptive qualitative design was used to analyze retrospective WhatsApp messages exchanged between health care providers and patients or caregivers from August 2022 to October 2022. An inductive qualitative content analysis approach was used to systematically identify and categorize emerging patterns in the data. The analysis of 1218 WhatsApp messages from 354 HaH admissions identified three main categories: (1) clinical checks and advice; (2) administrative and transport arrangements; and (3) quality of interpersonal dynamics, supported by 13 subcategories, reflecting both task-oriented and relational dimensions of communication. The findings highlight how asynchronous messaging enables continuous care coordination while fostering trust and engagement between health care providers, patients, and caregivers. This study underscores the multifaceted role of digital communication in HaH care, demonstrating its influence beyond clinical coordination to operational efficiency and the quality of interpersonal relationships. The findings provide insights into how digitally mediated interactions supported care delivery and patient engagement within a Singapore HaH program during the COVID-19 pandemic. While situated within a pandemic-specific context, these findings offer transferable considerations for the design of communication strategies and digital tools to enhance the responsiveness, coordination, and patient-centeredness of HaH programs.

Communication among health care professionals is essential for the delivery of safe clinical care. Secure messaging has rapidly emerged as a new mode of asynchronous communication. Despite its popularity, relatively little is known about how secure messaging is used and how such use contributes to communication burden. This study aims to characterize the use of an electronic health record–integrated secure messaging platform across 14 hospitals and 263 outpatient clinics within a large health care system. We collected metadata on the use of the Epic Systems Secure Chat platform for 6 months (July 2022 to January 2023). Information was retrieved on message volume, response times, message characteristics, messages sent and received by users, user roles, and work settings (inpatient vs outpatient). A total of 32,881 users sent 9,639,149 messages during the study. Median daily message volume was 53,951 during the first 2 weeks of the study and 69,526 during the last 2 weeks, resulting in an overall increase of 29% (P=.03). Nurses were the most frequent users of secure messaging (3,884,270/9,639,149, 40% messages), followed by physicians (2,387,634/9,639,149, 25% messages), and medical assistants (1,135,577/9,639,149, 12% messages). Daily message frequency varied across users; inpatient advanced practice providers and social workers interacted with the highest number of messages per day (median 19). Conversations were predominantly between 2 users (1,258,036/1,547,879, 81% conversations), with a median of 2 conversational turns and a median response time of 2.4 minutes. The largest proportion of inpatient messages was from nurses to physicians (972,243/4,749,186, 20% messages) and physicians to nurses (606,576/4,749,186, 13% messages), while the largest proportion of outpatient messages was from physicians to nurses (344,048/2,192,488, 16% messages) and medical assistants to other medical assistants (236,694/2,192,488, 11% messages). Secure messaging was widely used by a diverse range of health care professionals, with ongoing growth throughout the study and many users interacting with more than 20 messages per day. The short message response times and high messaging volume observed highlight the interruptive nature of secure messaging, raising questions about its potentially harmful effects on clinician workflow, cognition, and errors.

Communication among health care professionals is essential for effective clinical care. Asynchronous text-based clinician communication-secure messaging-is rapidly becoming the preferred mode of communication. The use of secure messaging platforms across health care institutions creates large-scale communication networks that can be used to characterize how interaction structures affect the behaviors and outcomes of network members. However, the understanding of the structure and interactions within these networks is relatively limited. This study investigates the characteristics of a large-scale secure messaging network and its association with health care professional messaging behaviors. Data on electronic health record-integrated secure messaging use from 14 inpatient and 282 outpatient practice locations within a large Midwestern health system over a 6-month period (June 1, 2023, through November 30, 2023) were collected. Social network analysis techniques were used to quantify the global (network)- and node (health care professional)-level properties of the network. Hierarchical clustering techniques were used to identify clusters of health care professionals based on network characteristics; associations between the clusters and the following messaging behaviors were assessed: message read time, message response time, total volume of messages, character length of messages sent, and character length of messages received. The dataset included 31,800 health care professionals and 7,672,832 messages; the resultant messaging network consisted of 31,800 nodes and 1,228,041 edges. Network characteristics differed based on practice location and professional roles (P<.001). Specifically, pharmacists and advanced practice providers, as well as those working in inpatient settings, had the highest values for all network metrics considered. Four clusters were identified, representing differences in connectivity within the network. Statistically significant differences across clusters were identified between all considered secure messaging behaviors (P<.001). One of the clusters with 1109 nodes, consisting mostly of physicians and other inpatient health care professionals, had the highest values for all node-level metrics compared to the other clusters found. This cluster also had the quickest message read and response times and handled the largest volume of messages per day. Secure messaging use within a large health care system manifested as an expansive communication network where connectivity varied based on a health care professional's role and their practice setting. Furthermore, our findings highlighted a relationship between health care professionals' connectivity in the network and their daily secure messaging behaviors. These findings provide insights into the complexities of communication and coordination structures among health care providers and downstream secure messaging use. Understanding how secure messaging is used among health care professionals can offer insights into interventions aimed at streamlining communication, which may, in turn, potentially enhance clinician work behaviors and patient outcomes.

Digital communication between nurses and medicine interns plays a crucial role in patient care. However, excessive messaging may contribute to alert fatigue, potentially affecting workflow efficiency and clinical decision-making. Although prior research has examined general messaging behaviors among clinicians, few studies have specifically analyzed messaging patterns between nurses and interns, who serve as primary points of contact in inpatient care. This study aims to quantitatively characterize messaging patterns between the primary nurse and primary provider (ie, medicine intern) of hospitalized patients at an academic medical center in order to identify communication burdens and potential inefficiencies. By identifying trends in message volume, timing, and response rates, we seek to inform strategies to optimize communication workflows and mitigate alert fatigue. At a large academic hospital (Tufts Medical Center, Boston, MA), we analyzed secure messaging transactions between internal medicine interns and nurses across three medical-surgical units over 6 months. Transaction metadata, time stamps, and unique message tokens were extracted. Data processing was performed using Python, Microsoft Excel, and R. Message volume, interaction frequencies, and response times were analyzed using measures of central tendency and statistical tests of significance. A total of 61,057 unique messages were exchanged between interns and nurses, with interns exchanging 2.5 times more messages per day with nurses than vice versa (P<.001). Messaging volume exhibited diurnal variation, indicating periods of increased communication burden. Interns read messages from nurses within a median of 35 (range: 0-3589) seconds, whereas nurses read messages from interns within a median of 26 (range: 0-3584) seconds (P<.001). The longest message response delays occurred at 4 AM, whereas the shortest occurred at 8 AM. Interns experience a significantly higher messaging burden than nurses, with distinct peaks in message volume during morning rounds and overnight shifts. These findings suggest a need for interventions such as optimized digital communication protocols to reduce nonessential messaging and alert fatigue. Future research should explore the effectiveness of these interventions in enhancing workflow efficiency and the development of both in-person and digital interventions to optimize communication workflows and mitigate alert fatigue.

Clinical communication is central to the delivery of effective, timely, and safe patient care. The use of text-based tools for clinician-to-clinician communication-commonly referred to as secure messaging-has increased exponentially over the past decade. The use of secure messaging has a potential impact on clinician work behaviors, workload, and cognitive burden. The objective of this study is to investigate the relationship between conversational multitasking-engaging in multiple concurrent, text-based secure messaging conversations-and clinician workload and cognitive burden for inpatient care. This observational cohort study included attending physicians, trainee physicians, and advanced practice providers who worked in an inpatient setting at 14 academic and community hospitals affiliated with a large academic medical center in the United States between February and April 2023. The primary exposure was the maximum number of concurrent secure messaging conversations a clinician engaged in during a workday. The co-primary outcomes were total time spent on the electronic health record (EHR; EHR time) and number of switches between patient charts (patient switching) on that workday. Linear mixed-effect models were used to measure the association between the maximum number of concurrent secure messaging conversations, EHR time, and patient switching on the clinician-day level, after adjusting for covariates (age, gender, total secure messaging volume, patient load, and clinical service assignments). In total, 50,027 clinician-days involving 3232 clinicians (1798 females, 56%; median age 37, IQR 32-46 y) and 3,556,562 secure messages were included. Median EHR time per day was 307 (IQR 204-413) minutes, and the median number of patient switches per day was 107 (IQR 60-176). Compared to clinician-days with no concurrent secure messaging conversations, engaging in a maximum of 2, 3, and 4 or more concurrent secure messaging conversations was associated with an increase in EHR time of 20.3 (95% CI 18.2-22.4), 38.0 (95% CI 34.9-41.1), and 54.8 (95% CI 50.6-58.9) minutes, respectively. Similarly, compared to clinician-days with no concurrent secure messaging conversations, engaging in a maximum of 2, 3, and 4 or more concurrent secure messaging conversations was associated with 14.5 (95% CI 11.3-17.7), 26.7 (95% CI 21.9-31.5), and 41.6 (95% CI 35.2-48.1) additional patient switches, respectively. Stratified analyses showed that trainees experienced the largest increases in EHR time (up to 82.3 min, 95% CI 73.2-91.4) and patient switches (up to 61.8, 95% CI 54.3-69.3). Higher levels of conversational multitasking were associated with increased EHR time and more patient switches in a dose-dependent manner. These results suggest that conversational multitasking may be linked with increased clinician workload and cognitive burden, emphasizing the need for guidelines and interventions to streamline secure messaging use in clinical practice.

WhatsApp is a popular messaging application frequently used by physicians and healthcare organizations that can improve the continuity of care and facilitate effective health services provision, especially in acute settings. However WhatsApp does not comply with the rules of the European GDPR and the US HIPA Act. So it is inappropriate to share clinical information via WhatsApp.For this reason alternatives to Whatsapp are considered. In particular, the features that must have secure messaging apps to be in compliance with GDPR and HIPAA and to protect patient data will be discussed. The aim is to encourage healthcare organizations and physicians to abandon WhatsApp and to adopt one of the many secure messaging apps now available, some of them at no cost.

Background Instant messaging applications and texting are useful for educating and communicating with medical students; however, they present patient privacy concerns and do not address the challenge of student inclusion in patient care communication. EMR-integrated secure messaging offers an opportunity to include students on team communication, enhance their medical education, and ensure patient privacy. Methods Between July 2019 through March 2020, we performed a mixed method study to evaluate use of EPIC® Secure Chat as a means of enhancing student education and team communication. We promoted use of secure messaging in orientation, performed a pre- and post-rotation survey to assess perceptions of Secure Chat effect on communication, and directly reviewed and categorized messages. Results Twenty-four 3rd and 4th year students completed the pre-rotation survey, and 22 completed the post-rotation survey. Twelve (50%) students reported the quality of communication with faculty was either good or very good prior to internal medicine rotation, while 20 (91%) reported this post-rotation (p-value 0.001). There was a similar improvement in communication with ancillary staff. Nineteen (86%) students felt that secure messaging improved their communication with faculty. On message review, threads were frequently logistical, but also often included discussions of patient management. Conclusions Students viewed Secure Chat as having a favorable effect on their communication with team members and reported communication on internal medicine to be improved compared to prior rotations. Messages included students on important patient care conversations. Secure messaging offers a novel medium to improve team communication, enhance student education, and maintain patient privacy.