背景:卫生保健专业人员之间的沟通对于提供安全的临床护理至关重要。安全消息作为异步通信的新模式迅速出现。尽管它很受欢迎,关于如何使用安全消息传递以及这种使用如何导致通信负担的知识相对较少。
目的:本研究旨在描述在大型医疗保健系统中的14家医院和263家门诊诊所中使用电子健康记录集成的安全消息传递平台的特征。
方法:我们收集了有关使用EpicSystems安全聊天平台6个月(2022年7月至2023年1月)的元数据。已检索有关邮件卷的信息,响应时间,消息特征,用户发送和接收的消息,用户角色,和工作设置(住院和门诊)。
结果:在研究期间,共有32,881名用户发送了9,639,149条消息。在研究的前2周内,每日消息量中位数为53,951,在最后2周内为69,526,导致整体增长29%(P=0.03)。护士是安全消息的最频繁用户(3,884,270/9,639,149,40%的消息),其次是医生(2,387,634/9,639,149,25%的信息),和医疗助理(135577/9639149,12%的信息)。每天的消息频率因用户而异;住院高级实践提供者和社会工作者每天与最高数量的消息互动(中位数19)。对话主要在2个用户之间(1,258,036/1,547,879,81%的对话),中位数为2次对话转弯,中位数响应时间为2.4分钟。住院患者信息比例最大的是护士到医生(972,243/4,749,186,20%信息)和医生到护士(606,576/4,749,186,13%信息),而门诊信息的最大比例是从医生到护士(344,048/2,192,488,16%的信息)和医疗助理到其他医疗助理(236,694/2,192,488,11%的信息)。
结论:各种医疗保健专业人员广泛使用安全消息,随着整个研究的持续增长,许多用户每天与20多条消息进行交互。观察到的短消息响应时间和高消息传递量突出了安全消息传递的中断性质,对其对临床工作流程的潜在有害影响提出质疑,认知,和错误。
Communication among health care professionals is essential for the delivery of safe clinical care. Secure messaging has rapidly emerged as a new mode of asynchronous communication. Despite its popularity, relatively little is known about how secure messaging is used and how such use contributes to communication burden.
This study aims to characterize the use of an electronic health record-integrated secure messaging platform across 14 hospitals and 263 outpatient clinics within a large health care system.
We collected metadata on the use of the Epic Systems Secure Chat platform for 6 months (July 2022 to January 2023). Information was retrieved on message volume, response times, message characteristics, messages sent and received by users, user roles, and work settings (inpatient vs outpatient).
A total of 32,881 users sent 9,639,149 messages during the study. Median daily message volume was 53,951 during the first 2 weeks of the study and 69,526 during the last 2 weeks, resulting in an overall increase of 29% (P=.03). Nurses were the most frequent users of secure messaging (3,884,270/9,639,149, 40% messages), followed by physicians (2,387,634/9,639,149, 25% messages), and medical assistants (1,135,577/9,639,149, 12% messages). Daily message frequency varied across users; inpatient advanced practice providers and social workers interacted with the highest number of messages per day (median 19). Conversations were predominantly between 2 users (1,258,036/1,547,879, 81% conversations), with a median of 2 conversational turns and a median response time of 2.4 minutes. The largest proportion of inpatient messages was from nurses to physicians (972,243/4,749,186, 20% messages) and physicians to nurses (606,576/4,749,186, 13% messages), while the largest proportion of outpatient messages was from physicians to nurses (344,048/2,192,488, 16% messages) and medical assistants to other medical assistants (236,694/2,192,488, 11% messages).
Secure messaging was widely used by a diverse range of health care professionals, with ongoing growth throughout the study and many users interacting with more than 20 messages per day. The short message response times and high messaging volume observed highlight the interruptive nature of secure messaging, raising questions about its potentially harmful effects on clinician workflow, cognition, and errors.