Description of Secure Chat Message Volume for Academic Pediatric Hospitalists

Secure text messaging systems (STMS) have transformed the way health care clinicians communicate. Although the benefits of rapid and easy communication among team members were anticipated, the volume of messages was less predictable. This study sought to quantify the volume of messages accessed (sent and received) by a pediatric hospitalist during a clinical shift.

Messages accessed by pediatric hospitalists during their shifts from November 16, 2024 through March 9, 2025 were counted and grouped according to shift (day 0700-1700, night 1701-0659). One daytime hospitalist had the additional role of triaging admission, consult, and transfer calls. Residents were listed as first contact for admitted patients. Daily census was tracked. Negative binomial regression was used to assess the relationship of message volume with different shifts and census.

A daytime pediatric hospitalist without triage responsibilities accessed a median of 50 (IQR: 26-95) messages per day, which was significantly less than with triage (109 [78-161] messages/d; P < .0001). The nighttime hospitalist accessed a median of 77 (51-133) messages per day. There was a positive association with morning census and volume of daytime messages (P = .0014). Overall, hospitalists received 34% more messages than they sent per day (P = .008).

Pediatric hospitalists accessed a high volume of STMS despite not being the assigned first contact. Higher morning census and triaging calls adds a significant volume of messages. Frequent messages may lead to alert fatigue, burnout, and inefficiency. Future steps include efforts to optimize the volume of messages and limit unnecessary distractions from patient care.