Appl Clin Inform 2017; 08(03): 742-753
DOI: 10.4338/ACI-2017-04-RA-0064
Research Article
Schattauer GmbH

Comparison of secure messaging application (WhatsApp) and standard telephone usage for consultations on Length of Stay in the ED

A prospective randomized controlled study
Umut Gulacti
1  Adiyaman University, Adiyaman, Turkey
Ugur Lok
1  Adiyaman University, Adiyaman, Turkey
› Author Affiliations
Further Information

Publication History

received: 18 April 2017

accepted in revised form: 11 May 2017

Publication Date:
20 December 2017 (online)


Objective: Consultation, the process of an Emergency Physician seeking an opinion from other specialties, occurs frequently in the Emergency Department (ED). The aim of this study was to determine the effect of secure messaging application (WhatsApp) usage for medical consultations on Emergency Department Length of Stay (ED LOS) and consult time. Methods: We conducted a prospective, randomized controlled trial in the ED using allocation concealment over three months. Consultations requested in the ED were allocated into two groups: consultations requested via the secure messaging application and consultations requested by telephone as verbal. Results: A total of 439 consultations requested in the ED were assessed for eligibility and 345 were included in the final analysis: 173 consultations were conducted using secure messaging application and 172 consultations were conducted using standard telephone communications. The median ED LOS was 240 minutes (IQR:230-270, 95% CI:240 to 255.2) for patients in the secure messaging application group and 277 minutes (IQR:270-287.8, 95% CI:277 to 279) for patients in the telephone group. The median total ED LOS was significantly lower among consults conducted using Secure messaging application relative to consults conducted by telephone (median dif: -30, 95%CI:–37to-25, p<0.0001). The median consult time was 158 minutes (IQR:133 to 177.25, 95% CI:150 to 169) for patients in the Secure messaging application group and 170 minutes (IQR:165 to 188.5, 95% CI:170-171) for patients in the Telephone group (median dif: –12, 95%CI:-19 to-7,p<0.0001). Consultations completed without ED arrival was 61.8% in the secure messaging group and 33.1% in the Telephone group (dif: 28.7, 95% CI:48.3 to 66, p<0.001). Conclusions: Use of secure messaging application for consultations in the ED reduces the total ED LOS and consultation time. Consultation with secure messaging application eliminated more than half of in-person ED consultation visits.

Gulacti U, Lok U. Comparison of secure messaging application (WhatsApp) and standard telephone usage for consultations on Length of Stay in the ED. Appl Clin Inform 2017; 8: 742–753

Clinical Relevance Statement

Smartphone use, including healthcare applications, has increased among health care professional such as physicians. The widespread use of smartphones represents a new opportunity to integrate mobile technology into daily clinical practice. The secure messaging application, the most popular messaging application for smartphones, has been used for clinical consultation, collaboration and communication between physicians in clinical practice. Our study demonstrates that secure messaging application use in the ED as new medical consultation method is useful.

Human Subjects Protections

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and approved by the Medical Ethics Committee (date/number: 2015/04–11).