Message madness: Characterization of electronic secure messages in the hospital

Hospital communication is increasingly reliant on asynchronous electronic secure messaging (SM) systems, with the unintended consequence of increased task switching and a greater overall burden of communications. We sought to analyze secure messages sent and received by hospitalists to understand content, urgency, and actionability, which may guide future efforts on best practices around SM.

A qualitative content analysis was performed on a subset of messages sent and received by hospitalists from 1 weekday and 1 weekend day in 2023, coding them by urgency (i.e., emergent, urgent, nonurgent), context (i.e., clinical, administrative), actionable/non-actionable, content (i.e., social, gratitude, acknowledgment, apology, completion notification), sentiment (i.e., positive, negative, neutral), and other key features (i.e., communication mode change, near miss/miss, presence of emoticon). Thematic analysis was then conducted on conversations that were length outliers, messages with emotion, messages indicating a change in communication mode, and messages with a near miss/miss.

A total of 2706 messages (365 conversations) were coded. These messages were sent and received by physicians (38%), advanced practice providers (22%), nurses (33%), and other team members (8%). The majority of these messages were "nonurgent" (99%), "clinical" (64%), and/or "non-actionable" (66%). Among these messages, nearly one-third were classified as acknowledgment (13%), gratitude (8%), acknowledgment and gratitude (8%), apology (2%), and social interactions (0.6%).

A majority of secure messages were nonurgent and non-actionable, with many containing lower acuity elements (e.g., acknowledgment, gratitude). Hospitals can explore minimizing this type of communication to help decrease task switching and cognitive burden.