Perfect Storm of Inpatient Communication Needs and an Innovative Solution Utilizing Smartphones and Secured Messaging

In hospitals, effective and efficient communication among care providers is critical to the provision of high-quality patient care. Yet, major problems impede communications including the frequent use of interruptive and one-way communication paradigms. This is especially frustrating for frontline providers given the dynamic nature of hospital care teams in an environment that is in constant flux.

We conducted a pre-post evaluation of a commercially available secured messaging mobile application on 4 hospital units at a single institution for over one year. We included care providers on these units: residents, hospitalists, fellows, nurses, social workers, and pharmacists. Utilization metrics and survey responses on clinician perceptions were collected and analyzed using descriptive statistics, the Kruskal-Wallis test, and Mann-Whitney U test where appropriate.

Between May 2013 and June 2014, 1,021 providers sent a total of 708,456 messages. About 85.5% of total threads were between two providers and the remaining were group messages. Residents and social workers/clinical resource coordinators were the largest per person users of this communication system, sending 9 (IQR 2-20) and 9 (IQR 2-22) messages per person per day, and receiving 18 (IQR 5-36) and 14 (IQR 5-29) messages per person per day, respectively (p=0.0001). More than half of the messages received by hospitalists, residents, and nurses were read within a minute. Communicating using secured messaging was found to be statistically significantly less disruptive to workflow by both nursing and physician survey respondents (p<0.001 for each comparison).

Routine adoption of secured messaging improved perceived efficiency among providers on 4 hospital units. Our study suggests that a mobile application can improve communication and workflow efficiency among providers in a hospital. New technology has the potential to improve communication among care providers in hospitals.