Overnight consult message volume and patterns to pediatric subspecialty fellows

In children's hospitals, pediatric subspecialists provide crucial diagnostic and therapeutic guidance for hospital-based clinicians around-the-clock. Consultation commonly occurs through secure text message systems (STMS) with potential important impacts on trainee sleep and wellbeing. We sought to quantify STMS metadata to on call subspeciality fellows overnight in a single children's hospital over a 6-month period (March to August 2024). We analyzed STMS metadata for message counts and timing patterns. We found significant differences in call shift message volume across subspecialists (p < .001). Fellows in the hospital received 32 more messages per shift compared to fellows at home (53 to 21; p < .001). We found significant differences in the median longest time between messages across subspecialties (p < .001), ranging from 1.6 to 10.0 h. Guidance on clinical workload duty hours for trainees was developed prior to technological advances in clinical communication and requires further evaluation considering overnight messaging burden and impact on sleep.