Appl Clin Inform 2016; 07(03): 777-789
DOI: 10.4338/ACI-2015-11-RA-0151
Research Article
Schattauer GmbH

Perfect Storm of Inpatient Communication Needs and an Innovative Solution Utilizing Smartphones and Secured Messaging

Neha Patel
1   Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
James E. Siegler
2   Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Nathaniel Stromberg
3   Center for Clinical Effectiveness & Quality Improvement, University of Pennsylvania Health System, Philadelphia, Pennsylvania
Neil Ravitz
4   Presbyterian Medical Center, Philadelphia, Pennsylvania
C. William Hanson
5   Department of Anesthesia, and Chief Medical Informatics Officer, University of Pennsylvania Health System, Philadelphia, Pennsylvania
› Author Affiliations
Further Information

Publication History

received: 14 November 2015

accepted: 27 March 2016

Publication Date:
19 December 2017 (online)



In hospitals, effective and efficient communication among care providers is critical to the provision of high-quality patient care. Yet, major problems impede communications including the frequent use of interruptive and one-way communication paradigms. This is especially frustrating for frontline providers given the dynamic nature of hospital care teams in an environment that is in constant flux.


We conducted a pre-post evaluation of a commercially available secured messaging mobile application on 4 hospital units at a single institution for over one year. We included care providers on these units: residents, hospitalists, fellows, nurses, social workers, and pharmacists. Utilization metrics and survey responses on clinician perceptions were collected and analyzed using descriptive statistics, the Kruskal-Wallis test, and Mann-Whitney U test where appropriate.


Between May 2013 and June 2014, 1,021 providers sent a total of 708,456 messages. About 85.5% of total threads were between two providers and the remaining were group messages. Residents and social workers/clinical resource coordinators were the largest per person users of this communication system, sending 9 (IQR 2–20) and 9 (IQR 2–22) messages per person per day, and receiving 18 (IQR 5–36) and 14 (IQR 5–29) messages per person per day, respectively (p=0.0001). More than half of the messages received by hospitalists, residents, and nurses were read within a minute. Communicating using secured messaging was found to be statistically significantly less disruptive to workflow by both nursing and physician survey respondents (p<0.001 for each comparison).


Routine adoption of secured messaging improved perceived efficiency among providers on 4 hospital units. Our study suggests that a mobile application can improve communication and workflow efficiency among providers in a hospital. New technology has the potential to improve communication among care providers in hospitals.

Citation: Patel N, Siegler JE, Stromberg N, Ravitz N, Hanson CW. Perfect storm of inpatient communication needs and an innovative solution utilizing smartphones and secured messaging.

  • References

  • 1 Block L, Habicht R, Wu AW, Desai SV, Wang K, Silva KN, Niessen T, Oliver N, Feldman L. In the wake of the 2003 and 2011 duty hours regulations, how do internal medicine interns spend their time?. J Gen Intern Med 2013; 28: 1042-1047.
  • 2 Hendrich A, Chow MP, Skierczynski BA, Lu Z. A 36-hospital time and motion study: How do medicalsurgical nurses spend their time?. Perm J 2008; 12: 25-34.
  • 3 Parker J, Coiera E. Improving clinical communication: A view from psychology. J Am Med Inform Assoc 2000; 07: 453-461.
  • 4 Wu RC, Tzanetos K, Morra D, Quan S, Lo V, Wong BM. Educational impact of using smartphones for clinical communication on general medicine: More global, less local. J Hosp Med 2013; 08: 365-372.
  • 5 Wu R, Lo V, Morra D, Appel E, Arany T, Curiale B, Ryan J, Quan S. A smartphone-enabled communication system to improve hospital communication: Usage and perceptions of medical trainees and nurses on general internal medicine wards. J Hosp Med 2015; 10: 83-89.
  • 6 McElroy LM, Ladner DP, Holl JL. The role of technology in clinician-to-clinician communication. BMJ Qual Saf 2013; 22: 981-983.
  • 7 Coiera E. When conversation is better than computation. J Am Med Inform Assoc 2000; 07: 277-286.
  • 8 Agarwal R, Sands DZ, Schneider JD. Quantifying the economic impact of communication inefficiencies in u.S. Hospitals. J Healthc Manag 2010; 55: 265-281.
  • 9 Coiera E, Tombs V. Communication behaviours in a hospital setting: An observational study. BMJ 1998; 316: 673-676.
  • 10 Quan SD, Wu RC, Rossos PG, Arany T, Groe S, Morra D, Wong BM, Cavalcanti R, Coke W, Lau FY. It’s not about pager replacement: An in-depth look at the interprofessional nature of communication in healthcare. J Hosp Med 2013; 08: 137-143.
  • 11 Patel SP, Lee JS, Ranney DN, Al-Holou SN, Frost CM, Harris ME, Lewin SA, Liu E, Madenci A, Majkrzak AA, Peterson SF, Serecky KA, Wilkinson DA, Wojcik BM, Englesbe MJ, Lynch RJ. Resident workload, pager communications, and quality of care. World J Surg 2010; 34: 2524-2529.
  • 12 Ortega GR, Taksali S, Smart R, Baumgaertner MR. Direct cellular vs. Indirect pager communication during orthopaedic surgical procedures: A prospective study. Technol Health Care 2009; 17: 149-157.
  • 13 Fortney JC, Burgess JF, Bosworth HB, Booth BM, Kaboli PJ. A reconceptualization of access for 21st century healthcare. J Gen Intern Med 2011; 26: 639-647.
  • 14 Greene AH. HIPAA Compliance for clinician texting. J AHIMA 2012; 83: 34-36.
  • 15 Przybylo JA, Wang A, Loftus P, Evans KH, Chu I, Shieh L. Smarter hospital communication: Secure smartphone text messaging improves provider satisfaction and perception of efficacy, workflow. J Hosp Med 2014; 09: 573-578.
  • 16 Wu R, Rossos P, Quan S, Reeves S, Lo V, Wong B, Cheung M, Morra D. An evaluation of the use of smartphones to communicate between clinicians: A mixed-methods study. J Med Internet Res 2011; 13: e59.
  • 17 Vazirani S, Hays R, Shapiro M, Cowan M. Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. Am J Crit Care 2005; 14: 71-77.
  • 18 Baker DP, Day R, Salas E. Teamwork as an essential component of high-reliability organizations. Health Serv Res 2006; 41: 1576-1598.
  • 19 Rivera AJ, Karsh BT. Interruptions and distractions in healthcare: review and reappraisal. Qual Saf Health Care 2010; 19: 304-312.
  • 20 Wu RC, Lo V, Morra D, Wong BM, Sargeant R, Locke K, Cavalcanti R, Quan SD, Rossos P, Tran K, Cheung M. The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals. J Am Med Inform Assoc 2013; 20: 766-777.
  • 21 Wu RC, Morra D, Quan S, Lai S, Zanjani S, Abrams H, Rossos PG. The use of smartphones for clinical communication on internal medicine wards. J Hosp Med 2010; 05: 553-559.
  • 22 Khanna RR, Wachter RM, Blum M. Reimaging electronic clinical communication in the post-pager, smartphone era. JAMA 2016; 315 (01) 22.