Background: Today’s care of patients in hospitals inevitably involves multiple providers who must coordinate and communicate effectively in an environment that is uncertain and in constant flux. Unfortunately, traditional communication systems, such as pagers or landlines, have limitations that lead to frequent interruptions, inability to indicate the urgency of a message, delay in contacting the right provider, and limitations of asynchronous communication, that is, messaged that are separated by time. To address these clinical communication issues, hospitals are beginning to implement various solutions, inducing instant messaging or smartphone based email or voice calls or Health Insurance Portability and Accountability Act (HIPAA) compliant messages. To the best of our knowledge, this is the first study to evaluate the long-term utilization and impact of a HIPAA compliant messaging application in a hospital setting.
Methods: This was a pre-post mixed methods study utilizing both quantitative and qualitative measures. The study was conducted on 3 medical units and 1 surgical unit in an academic medical center. Beginning May 2013, providers, including bedside nurses, social workers, clinical resource coordinators, pharmacists, residents, and hospitalists, pn the four pilot units were asked to use Cureatr, a mobile application, to communicate all non-urgent patient care information. Cureatr is a HIPAA-compliant communication platform for select smart devices, such as Android and iOS products. Providers who did not routinely utilize smartphones in their daily clinical workflow were provided either iPhones or iTouches . Proper use of the application was demonstrated by clinical champions who had been trained prior to implementation of the intervention. Minimal resources were provided for ongoing training for using Cureatr, despite the high turnover of providers on these units, in order to evaluate for usability, feasibility, and sustainability of the new communication mobile application.
Results: During the 13-month study period, a total of 721,820 messages were sent; 588,589 individual and 133,231 group messages. Nurses and residents represented the majority of senders (43%, 308,186 messages and 32%, 228,938 messages, respectively). Over half of all messages resulted in responses within less than 1 minute. Fifty four percent of messages (214,119) received by residents were read in less than one minute and 49% (173,832) of messages received by nurses were read in less than one minute. On average, residents received double the amount of messages compared to nurses (25 vs 11, respectively). As a result of using the mobile app, 40% of nurses reported saving about an hour daily and 40% of physicians reported saving about 1 to 3 hours a day. The largest improvement in operational efficiencies was seen on the surgical unit (6.0 vs 5.5 length of stay and mean improvement of discharge time by 27 minutes).
Conclusions: We found that a mobile application to communicate non-urgent messages among providers in a hospital setting was well-received and highly utilized. Our results showed improvements in operational metrics, such as length of stay and discharge time, increased efficiency of communication between nurses and physicians, and reported significant time saved in a given typical work day. Whether this feasible, low-cost intervention is associated with more effective intra-provider communication is to be determined.