Inbox Messaging: an effective tool for minimizing non-urgent paging related interruptions in hospital medicine...

Communication is one of the foundations on which safe, high quality care is built.^{1, 3, 6, 17, 20} The nature of hospital medicine requires that nurses and providers be efficient and effective in communicating with multiple disciplines.¹⁷ This need for timely communication must continually be balanced with the need to minimize interruptions in workflow.^{1,2 3,4,6,7,9,13,15,17,18} Interruptions not only lead to distraction, they also add inefficiency to the care process and have been shown to contribute to an increased risk of medical error.^{2,3,4,7,17,18} A major source of interruptions are pagers that emit an audible tone with each message received.^3,9,10,17,18 This interruptive nature makes pagers a less-than-ideal tool for communicating non-urgent (address within one hour) messages received.^3,9,10,17,18 In addition to increasing interruptions, pagers do not facilitate closed loop communication, another feature that has been shown to improve safety.^14,17,25 Inbox Messaging is intended to provide a less disruptive closed-loop method of communication for non-urgent messages. Inbox Messaging is an interface within the electronic health record (EHR) that functions similarly to e-mail. A multi-disciplinary communication workgroup identified this interface as having potential to not only decrease interruptions, but to also facilitate closed-loop communication. Inbox is currently utilized between the hours of 0700 and 1800 for non-urgent nurse-provider communication about patients on the hospital medicine service. The number of RN non-urgent pages per day was 103 (SD=19, n=97) prior to the Inbox intervention, with a significant decrease (p<.001) during follow-up to 38 (SD=14, n=354) pages per day. At the same time, the number of messages per day increased from 0 to 80 (SD=20, n=354) messages during follow-up. As desired, the mean number of RN urgent pages was unchanged from 13 per day to 13 per day (p=.52). Cerner Inbox Messaging decreases the frequency of non-urgent pager-related interruptions in workflow.