Qualitative Analysis of Team Communication with a Clinical Texting System at a Midwestern Academic Hospital

Abstract

Background Hospitals are increasingly replacing pagers with clinical texting systems that allow users to use smartphones to send messages while maintaining compliance for privacy and security. As more institutions adopt such systems, the need to understand the impact of such transitions on team communication becomes ever more significant. Methods We conducted focus groups with hospitalists and individual interviews with nurses at one academic medical center in the Midwest. All interviews and focus groups were audiorecorded, transcribed, and deidentified for analysis. All transcripts and notes were independently read by two members of the research team and coded for themes. Results Twenty-one hospitalists and eight nurses participated in the study. Although study participants spoke favorably of texting, they identified more dissatisfactions with texting than benefits. There were disagreements regarding appropriate texting practices both within and between the hospitalists and nurses. Conclusion Despite the benefits of texting, there is room for improving team communication and understanding in the realm of clinical texting. A lack of shared understanding regarding when and how to use texting may require long-term solutions that address teamwork and appropriateness.

Content Analysis of Emoji and Emoticon Use in Clinical Texting Systems

“…Phatic uses signaled that a message had been received or that a plan of action had been acknowledged. This usage is notable, as one study found that some clinicians are frustrated by receiving phatic messages along the lines of “OK thanks,” believing the additional message to be a superfluity and a burden on their time . However, such phatic acknowledgment may also serve the clinically relevant function of confirming a shared understanding of a given medical situation.…”

“…Our findings also echo those of a focus group on user experiences with clinical texting. In that study, Lee and colleagues discovered that while some users complained about the use of emoji in texts from nurses, others defended it as a way of conveying positive affect. For instance, one participant stated, “The emoji allows there to be another layer of personal interaction.” In our study, even ideograms that conveyed negative affect typically did so in a way that could serve to improve or reinforce the sender’s relationship with the addressee, as has been found in others studies .…”

Privacy and confidentiality of emergency department patient information: Contemporary considerations and challenges

“…The benefits were ease of access, ability to send pictures, and ability to have a record of the conversation. The risks were implementation challenges, high volume of texts, and lack of shared understanding about appropriate texting 23 . One of the authors found the secure chat to be an effective and HIPAA‐secure manner of initiating admission to the hospitalist service from the ED.…”

Texting is caring: a content analysis of clinical text messages by hospitalists

“…4 5 Despite the prevalence of CTS in clinical care today, little is known about how clinicians use these systems to deliver care and what they are texting when they do. 6 The adoption of CTS has led some clinicians to express concern about its appropriate use, [7][8][9] especially in the context of the high volume of alerts and messages received in a work day. A high volume of messages has been associated with physician burnout and dissatisfaction with time spent on clerical tasks.…”

“…10 Furthermore, evaluations of user experiences with CTS have found interprofessional tension in some settings, as some clinicians have expressed frustration about perceived misuse of CTS by others, or receiving messages deemed as 'unnecessary'. [7][8][9] Few studies to date, however, have examined the content of the messages being sent. Doing so requires in-depth content analysis of messages.…”