Appl Clin Inform 2019; 10(03): 471-478
DOI: 10.1055/s-0039-1692401
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Inpatient Communication Networks: Leveraging Secure Text-Messaging Platforms to Gain Insight into Inpatient Communication Systems

Philip A. Hagedorn
1  Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Eric S. Kirkendall
2  Department of Pediatrics, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States
S. Andrew Spooner
1  Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Vishnu Mohan
3  Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
› Author Affiliations
Further Information

Publication History

18 January 2019

29 April 2019

Publication Date:
26 June 2019 (online)


Objective This study attempts to characterize the inpatient communication network within a quaternary pediatric academic medical center by applying network analysis methods to secure text-messaging data.

Methods We used network graphing and statistical software to create network models of an inpatient communication system with secure text-messaging data from physicians, nurses, and other ancillary staff in an academic medical center. Descriptive statistics about the network, users within the network, and visualizations informed the team's understanding of the network and its components.

Results Analysis of messages exchanged over approximately 23 days revealed a large, scale-free network with 4,442 nodes and 59,913 edges. Quantitative description of user behavior (messages sent and received) and network metrics (i.e., importance of nodes within a network) revealed several operational and clinical roles both sending and receiving > 1,000 messages over this time period. While some of these nodes represented expected “dispatcher” roles in our inpatient system, others occupied important frontline clinical roles responsible for bedside clinical care.

Conclusion Quantitative and network analysis of secure text-messaging logs revealed several key operational and clinical roles at risk for alert fatigue and information overload. This analysis also revealed a communication network highly reliant on these key roles, meaning disruption to these individuals or their workflows could lead to dysfunction of the communication network. While secure text-messaging applications play increasingly important roles in facilitating inpatient communication, little is understood about the impact these systems have on health care providers. Developing methods to understand and optimize communication between inpatient providers might help operational and clinical leaders to proactively prevent poorly understood pitfalls associated with these systems and build resilient and effective communication structures.

Protection of Human and Animal Subjects

This work was deemed not human subjects related by our local institutional review boards.