title: Inbox Messaging: an effective tool for minimizing non-urgent paging related interruptions in hospital medicine provider workflow.
abstract: Communication is one of the foundations on which safe, high quality care is built.1, 3, 6, 17, 20The nature of hospital medicine requires that nurses and providers be efficient and effective in communicating with multiple disciplines.17This need for timely communication must continually be balanced with the need to minimize interruptions in workflow.1,2 3,4,6,7,9,13,15,17,18Interruptions not only lead to distraction, they also add inefficiency to the care process and have been shown to contribute to an increased risk of medical error.2,3,4,7,17,18A major source of interruptions are pagers that emit an audible tone with each message received.3,9,10,17,18This interruptive nature makes pagers a less-than-ideal tool for communicating non-urgent (address within one hour) messages received.3,9,10,17,18In addition to increasing interruptions, pagers do not facilitate closed loop communication, another feature that has been shown to improve safety.14,17,25Inbox Messaging is intended to provide a less disruptive closed-loop method of communication for non-urgent messages. Inbox Messaging is an interface within the electronic health record (EHR) that functions similarly to e-mail. A multi-disciplinary communication workgroup identified this interface as having potential to not only decrease interruptions, but to also facilitate closed-loop communication. Inbox is currently utilized between the hours of 0700 and 1800 for non-urgent nurse-provider communication about patients on the hospital medicine service. The number of RN non-urgent pages per day was 103 (SD=19, n=97) prior to the Inbox intervention, with a significant decrease (p<.001) during follow-up to 38 (SD=14, n=354) pages per day. At the same time, the number of messages per day increased from 0 to 80 (SD=20, n=354) messages during follow-up. As desired, the mean number of RN urgent pages was unchanged from 13 per day to 13 per day (p=.52). Cerner Inbox Messaging decreases the frequency of non-urgent pager-related interruptions in workflow.
authors.affiliation: Virginia Mason Medical Center, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Ferguson
authors.affiliation: Virginia Mason Medical Center, USA.
authors.forename: Barry
authors.initials: B
authors.lastname: Aaronson
authors.affiliation: Virginia Mason Medical Center, USA.
authors.forename: Anuradhika
authors.initials: A
authors.lastname: Anuradhika