Background: Communication in acute care settings is fragmented and inefficient, and consequently, patients and providers are often not “on-the-same-page” with regard to the plan of care. Care team members frequently communicate asynchronously via alpha-numeric pagers, email, internal electronic health record messaging, and increasingly, non-secure texting. To improve the acute care communication space, we engaged stakeholders in the design and development of a web-based and mobile patient-centered messaging platform that incorporated key attributes of microblogs. The platform, developed in collaboration with a secure messaging vendor and integrated with our electronic health record, was configured to facilitate more seamless communication by accurately identifying care team members, directing providers to a single conversation thread on which to view and contribute to the patient’s plan of care discussion, and integrating with an acute care patient portal to message patients and caregivers.
Purpose: We report our experience at implementing a patient-centered ‘microblog’ messaging platform as part of two research initiatives to improve care team communication in the hospital.
Description: Figure 1 illustrates key features and functions of the system. We piloted the system on critical and non-critical care units over a 6-month period. Use was sustained over the course of the study but varied by unit. Of 497 patients admitted to the critical care unit, messages were sent on 175 (35.2%): 914 (98.5%) and 14 (1.5%) messages were sent to other care team members and patients, respectively, by 180 providers in various roles. The median number of messages per patient was 3 (IQR 1, 5). The median time to view messages was 3h 1m (IQR 0h 1m, 18h 1m). Based on content analysis, provider-initiated messages were categorized into one or more major themes (Table 1), including care coordination (49%), clinical summarization (29%), and care team collaboration (27%). Of 43 clinicians surveyed, 29 (67%) responded and agreed that transparent conversation threads (83%) and persistence of messages (62%) were the most useful features; availability of alternative asynchronous messaging tools such as email (83%) and variable use by non-unit based providers (76%) were the main barriers to adoption. From informal feedback, most patients, clinical staff, and key stakeholders believed that the system has the potential to improve care team communication despite the barriers encountered.
Conclusions: Overall, our experience at implementing a patient-centered ‘microblog’ messaging platform to improve care team communication was favorable. Although adoption was variable, it primarily reflected our limited deployment–the perceived barriers do not seem insurmountable. Our next steps are to address barriers and implement more broadly at our institution.