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

Abstract

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.14,17,25Inbox 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.

A Matter of Urgency: Reducing Clinical Text Message Interruptions During Educational Sessions

“…For example, different assessor training backgrounds, different numbers of assessors, and varying institutional policies are described. [13][14][15][16][17] We considered an urgent message to require a response or action within one hour or to represent an established "critical lab value" as per the institution. The high proportion of nonurgent interruptions found in this study and other works demonstrates the widespread nature of this problem within inpatient hospital settings; this phenomenon could potentially lead to unintended consequences on efficiency and medical education.…”

Understanding the means of communication between nurses and resident physicians in the modern world: A community-based university hospital survey results

“…As well, all the reported substitutive means of communication that basically relied on alternative means of communication failed to replace the conventional direct communication between RP and nurses and rather supported the fact that its role is complementary rather than substitutive one [4][5][6][7].…”

“…And while we have better understood the value of this communication and the teamwork between nurses and residents, especially to ensure patient safety and a high value of care, newer means of communication have been implemented, typically through the technology available in the medical field, namely the electronic medical records (EMR) [2,3]. Many published data and studies in the literature have explored different means of communication between nurses and resident physicians (RP) [4][5][6][7]. While many agreed that there is a large number of calls or pages for non-urgent matters, others suggested using text messages or the EMR to decrease the burden of direct calls through pages and/or phone calls between nurses and residents [4][5][6][7].…”

“…Many published data and studies in the literature have explored different means of communication between nurses and resident physicians (RP) [4][5][6][7]. While many agreed that there is a large number of calls or pages for non-urgent matters, others suggested using text messages or the EMR to decrease the burden of direct calls through pages and/or phone calls between nurses and residents [4][5][6][7]. These suggestions are to decrease that burden of calls and direct communication and improve the workflow while sustaining a high level of patient care and safety.…”

Challenges in Communication from Referring Clinicians to Pathologists in the Electronic Health Record Era

“…[ 6 ] EHRs have been less robust in facilitating interpersonal, adaptive communication that is intrinsic to patient management and that often happens in iterative cycles between care providers to refine and formulate an accurate final diagnosis. [ 7 8 ] The EHRmsg function offers potential for secure, less disruptive, asynchronous, interpersonal, nonverbal, nonurgent, patient care communication[ 9 ] and has become an increasingly used modality for dialog among interdisciplinary clinical care providers. Reports to date have not studied clinician–surgical pathologist communication through EHRmsg.…”