343 - Disrupting Workflow or Improving Communication? Clinician Experiences with Secure Text Messaging

Publication Number: 4336.343

Ryan H. Lindstrom, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Kristin Tiedt, University of Minnesota Masonic Children's Hospital, minneapolis, MN, United States; Daniel Sklansky, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Kristin A. Shadman, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States

Background: Secure text messaging (STM) has been implemented in many hospitals, sometimes replacing pagers as the primary method of communication. Recent post-implementation studies have shown growing dissatisfaction with STM.

Objective: We assessed stakeholder opinions about STM use and STM impact on interdisciplinary relationships.

Design/Methods: A survey was constructed with a knowledge, attitudes, and beliefs framework, assessing STM use at a university-affiliated tertiary care Midwest pediatric hospital via mixed-format Likert scale items. Faculty, residents, and nurses were surveyed anonymously via email and posters with QR codes over one month. Data were analyzed using GraphPad Prism version 10.4.2(633), with non-parametric testing. The Wilcoxon signed-rank test was used to compare the sample median against the hypothetical median of “Neither agree nor disagree” (3). Mann–Whitney and Kruskal-Wallis tests were used for paired, and multiple group comparisons, respectively, with a two-tailed p < .05. The University of Wisconsin Institutional Review Board deemed this study IRB exempt through the program improvement pathway.

Results: The sample included 22 pediatric residents (47% response rate), 35 nurses, and 37 faculty physicians for a total of 94 participants, with fluctuating denominators for non-resident staff. 45% of residents found STM interrupted (median “agree”) and negatively impacted their workflow (median “agree”), while no nurses reported a negative effect. (median “not at all”). Faculty (median “1-2 times”, SD 1.06) and residents (median “3-4 times”, SD 0.959) reported receiving STMs that should have been pages, and pages that should have been STMs (median “1-2 times” SD 1.16, median “5-6 times” SD 1.33). In contrast, 95% of nurses reported using appropriate content for each messaging type. Faculty and residents were neutral about STM impact on relationships with nursing (42%, 32%), while 84% of nurses reported improved relationships with residents from STM. Faculty and residents preferred in-person communication with nursing (51%, 68%), while 77% of nurses preferred STM with physicians.

Conclusion(s): In this local sample, faculty and residents reported negative workflow, content, and relationship sequelae attributed to STM, while nurses reported improved workflow, communication content, and relationships attributed to STM. This discordance suggests that STM may lead to conflict due to misaligned perceptions of usage, with possible impact of patient care. Multidisciplinary work is needed to establish and study best practices and outcomes in STM.

Figure 1: Resident and nursing perception of STM impact and workflow interruption.
STMSurveyFigure1.pdfa) Residents were asked in if STM negatively impacted, positively impacted, and interrupted their workflow (N=22), with comparisons using Kruskal-Wallis with Dunn’s multiple comparisons with p <0.05. b) Nurses were asked how STM impacted their medication administration workflow (N=32), with data displayed as a percentage of the whole.

Figure 2: Residents, faculty and nursing perception of content matched with messaging modality.
STMSurveyFigure2.pdfa) Residents (N=22) and faculty (N=37) perceived frequency of messages that were an inappropriate communication modality per block of inpatient time, with data analyzed via Mann-Whitney two-tailed analysis with an assumed p <0.05. b) Nurses (N=35) were asked for their confidence in choosing the appropriate messaging modality for their intended content, with responses displayed as percentage of the whole.

Figure 3: Perceived STM impact on interdisciplinary relationships
STMSurveyFigure3.pdfNurse, (N=32) resident (N=22), and faculty (N=36) perception of interdisciplinary relationships after STM usage.