Academic hospitalist perspectives on the benefits and challenges of secure messaging: A mixed methods analysis.
Journal
Journal of hospital medicine
ISSN: 1553-5606
Titre abrégé: J Hosp Med
Pays: United States
ID NLM: 101271025
Informations de publication
Date de publication:
02 Oct 2024
02 Oct 2024
Historique:
revised:
13
09
2024
received:
19
06
2024
accepted:
19
09
2024
medline:
3
10
2024
pubmed:
3
10
2024
entrez:
3
10
2024
Statut:
aheadofprint
Résumé
Hospitals and patients rely on effective clinician communication. Asynchronous electronic secure messaging (SM) systems are a common way for hospitalists to communicate, but few studies have evaluated how hospitalists are navigating the adoption of SM and the benefits and challenges they are encountering. The objective of this study is to assess academic hospitalist perspectives on SM to guide future research and quality improvement initiatives. This was a mixed methods study utilizing an embedded REDCap survey and six virtual semistructured focus groups. It took place during a Hospital Medicine ReEngineering Network Zoom meeting on October 13, 2023. Rapid qualitative methods were used to define major themes. There were 28 hospitalists and one patient representative across 24 separate academic institutions. There was a 71% survey completion rate (N = 20). SM was felt to be an effective and efficient communication modality but was associated with a large amount of multitasking and interruptions. Perspectives around SM clustered around three main themes: SM has been widely but variably adopted; there is a lack of institutional guidance about how to best engage with SM; and SM is changing the landscape of hospitalist work by increasing ease but decreasing depth of communication, increasing cognitive load, and changing interpersonal relationships. Recommendations for SM improvements included the need for institutions to work with frontline workers to develop and implement clear usage guidelines. SM is likely contributing to both positive and negative effects for clinicians and patients. Understanding hospitalist perspectives on SM will help guide future research and quality improvement initiatives.
Sections du résumé
BACKGROUND
BACKGROUND
Hospitals and patients rely on effective clinician communication. Asynchronous electronic secure messaging (SM) systems are a common way for hospitalists to communicate, but few studies have evaluated how hospitalists are navigating the adoption of SM and the benefits and challenges they are encountering.
OBJECTIVES
OBJECTIVE
The objective of this study is to assess academic hospitalist perspectives on SM to guide future research and quality improvement initiatives.
METHODS
METHODS
This was a mixed methods study utilizing an embedded REDCap survey and six virtual semistructured focus groups. It took place during a Hospital Medicine ReEngineering Network Zoom meeting on October 13, 2023. Rapid qualitative methods were used to define major themes.
RESULTS
RESULTS
There were 28 hospitalists and one patient representative across 24 separate academic institutions. There was a 71% survey completion rate (N = 20). SM was felt to be an effective and efficient communication modality but was associated with a large amount of multitasking and interruptions. Perspectives around SM clustered around three main themes: SM has been widely but variably adopted; there is a lack of institutional guidance about how to best engage with SM; and SM is changing the landscape of hospitalist work by increasing ease but decreasing depth of communication, increasing cognitive load, and changing interpersonal relationships. Recommendations for SM improvements included the need for institutions to work with frontline workers to develop and implement clear usage guidelines.
CONCLUSION
CONCLUSIONS
SM is likely contributing to both positive and negative effects for clinicians and patients. Understanding hospitalist perspectives on SM will help guide future research and quality improvement initiatives.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 Society of Hospital Medicine.
Références
Taylor N, Clay‐Williams R, Hogden E, Braithwaite J, Groene O. High performing hospitals: a qualitative systematic review of associated factors and practical strategies for improvement. BMC Health Serv Res. 2015;15:244. doi:10.1186/s12913-015-0879-z
Burgener AM. Enhancing communication to improve patient safety and to increase patient satisfaction. Health Care Manag (Frederick). 2017;36(3):238‐243. doi:10.1097/HCM.0000000000000165
Humphrey KE, Sundberg M, Milliren CE, Graham DA, Landrigan CP. Frequency and nature of communication and handoff failures in medical malpractice claims. J Patient Safety. 2022;18(2):130‐137. doi:10.1097/pts.0000000000000937
Mehrzad R, Barza M. Are physician pagers an outmoded technology? Technol Health Care. 2015;23(3):233‐241. doi:10.3233/thc-140865
Liu X, Sutton P, McKenna R, et al. Evaluation of secure messaging applications for a health care system: a case study. Appl Clin Inform. 2019;10(1):140‐150. doi:10.1055/s-0039-1678607
Sakumoto M, Khanna R. Using technology to enhance communication. Med Clin North Am. 2022;106(4):705‐714. doi:10.1016/j.mcna.2022.01.010
Luu T, Spiegelman L, Nykin D, et al. Implementation of an electronic health record‐based messaging system in the emergency department: effects on physician workflow and resident burnout. J Patient Safety. 2022;18(2):e542‐e546. doi:10.1097/pts.0000000000000869
Chandra S, Oberg M, Hilburn G, Wu DT, Adhyaru BB. Improving communication in a large urban academic safety net hospital system: implementation of secure messaging. J Med Syst. 2023;47(1):56. doi:10.1007/s10916-023-01956-x
Martin G, Khajuria A, Arora S, King D, Ashrafian H, Darzi A. The impact of mobile technology on teamwork and communication in hospitals: a systematic review. J Am Med Inform Assoc. 2019;26(4):339‐355. doi:10.1093/jamia/ocy175
Przybylo JA, Wang A, Loftus P, Evans KH, Chu I, Shieh L. Smarter hospital communication: secure smartphone text messaging improves provider satisfaction and perception of efficacy, workflow. J Hosp Med. 2014;9(9):573‐578. doi:10.1002/jhm.2228
Hagedorn PA, Singh A, Luo B, Bonafide CP, Simmons JM. Secure text messaging in healthcare: latent threats and opportunities to improve patient safety. J Hosp Med. 2020;15(6):378‐380. doi:10.12788/jhm.3305
Lieu TA, Warton EM, East JA, et al. Evaluation of attention switching and duration of electronic inbox work among primary care physicians. JAMA Netw Open. 2021;4(1):e2031856. doi:10.1001/jamanetworkopen.2020.31856
Ercole A, Tolliday C, Gelson W, et al. Moving from non‐emergency bleeps and long‐range pagers to a hospital‐wide, EHR‐integrated secure messaging system: an implementer report. BMJ Health Care Inform. 2023;30(1):e100706. doi:10.1136/bmjhci-2022-100706
Aziz S, Barber J, Singh A, Alayari A, Rassbach CE. Resident and nurse perspectives on the use of secure text messaging systems. J Hosp Med. 2022;17(11):880‐887. doi:10.1002/jhm.12953
Small W, Iturrate E, Austrian J, Genes N. Electronic health record messaging patterns of health care professionals in inpatient medicine. JAMA Netw Open. 2023;6(12):e2349136. doi:10.1001/jamanetworkopen.2023.49136
Creswell JW, PlanoClark VL. Designing and Conducting Mixed Methods Research. 2nd ed. SAGE Publications, Inc; 2011.
Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs‐principles and practices. Health Serv Res. 2013;48(6 Pt 2):2134‐2156. doi:10.1111/1475-6773.12117
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)‐‐a metadata‐driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42(2):377‐381. doi:10.1016/j.jbi.2008.08.010
Auerbach AD, Patel MS, Metlay JP, et al. The Hospital Medicine ReEngineering Network (HOMERuN): a learning organization focused on improving hospital care. Acad Med. 2014;89(3):415‐420. doi:10.1097/acm.0000000000000139
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32‐item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349‐357. doi:10.1093/intqhc/mzm042
Keniston A, McBeth L, Astik G, et al. Practical applications of rapid qualitative analysis for operations, quality improvement, and research in dynamically changing hospital environments. Joint Comm J Qual Patient Safety. 2023;49(2):98‐104. doi:10.1016/j.jcjq.2022.11.003
Lewinski AA, Crowley MJ, Miller C, et al. Applied rapid qualitative analysis to develop a contextually appropriate intervention and increase the likelihood of uptake. Med Care. 2021;59(suppl 3):S242‐S251. doi:10.1097/mlr.0000000000001553
Carter N, Bryant‐Lukosius D, DiCenso A, Blythe J, Neville AJ. The use of triangulation in qualitative research. Oncol Nurs Forum. 2014;41(5):545‐547. doi:10.1188/14.Onf.545-547
Fusch P, Fusch GE, Ness LR. Denzin's paradigm shift: revisiting triangulation in qualitative research. J Soc Change. 2018;10(1):19‐32. doi:10.5590/JOSC.2018.10.1.02
Dodgson JE. Reflexivity in qualitative research. J Hum Lact. 2019;35(2):220‐222. doi:10.1177/0890334419830990
Wu R, Lo V, Morra D, et al. A smartphone‐enabled communication system to improve hospital communication: usage and perceptions of medical trainees and nurses on general internal medicine wards. J Hosp Med. 2015;10(2):83‐89. doi:10.1002/jhm.2278
Naik H, Murray TM, Khan M, et al. Population‐based trends in complexity of hospital inpatients. JAMA Int Med. 2024;184(2):183‐192. doi:10.1001/jamainternmed.2023.7410
Brickson C, Keniston A, Knees M, Burden M. Characterizing electronic messaging use among hospitalists and its association with patient volumes. J Hosp Med. Published online July 21, 2024. doi:10.1002/jhm.13462
Sloane JF, Donkin C, Newell BR, Singh H, Meyer AND. Managing interruptions to improve diagnostic decision‐making: strategies and recommended research agenda. J Gen Intern Med. 2023;38(6):1526‐1531. doi:10.1007/s11606-022-08019-w
Berg LM, Källberg AS, Göransson KE, Östergren J, Florin J, Ehrenberg A. Interruptions in emergency department work: an observational and interview study. BMJ Qual Safety. 2013;22(8):656‐663. doi:10.1136/bmjqs-2013-001967
Grundgeiger T, Sanderson P, MacDougall HG, Venkatesh B. Interruption management in the intensive care unit: predicting resumption times and assessing distributed support. J Exp Psychol Appl. 2010;16(4):317‐334. doi:10.1037/a0021912
Harris E, Santhosh L. Dual process theory and cognitive load. Crit Care Clin. 2022;38(1):27‐36. doi:10.1016/j.ccc.2021.07.001