Texting Between Clinicians Has Upsides and Downsides

A new study out of the Regenstrief Institute finds doctors critical of the high volume of texts, while nurses are OK with it.

As hospitals replace pagers with smartphone-based texting platforms connecting doctors, nurses, and other clinicians, some are giving mixed reviews to the technology.

So says a new study from the Regenstrief Institute, published in the journal Applied Clinical Informatics, which found a lack of shared understanding among clinicians on how to use clinical texting.

"Clinical texting is a double-edged sword – it’s easy to contact fellow clinicians, which can be viewed as good or bad," says Joy L. Lee, PhD, M.S., a Regenstrief Institute scientist, assistant professor of medicine at the Indiana University School of Medicine and corresponding author of the study. "Each hospital or hospital system needs to figure out how to use clinical texting to optimize communication, workflow and patient care and develop use guidelines."

In the study, nurses and hospitalists supported clinical texting, noting ease of access and the ability to transmit photos and create a record of communications. But they were also frustrated with implementation challenges and a lack of understanding about the appropriateness of texts.

Doctors in particular criticized the high volume of texts, though nurses did not.

With clinical texting guidelines and etiquette, Lee says, one size may not fit all.

The study’s authors created a checklist of considerations to take full advantage of the benefits of clinical texting, diminish user dissatisfaction, and create shared understanding of use. They recommend creating team buy-in and developing user consensus on aspects of appropriateness, such as when it would or would not be appropriate to text a non-urgent message.

The study, “Qualitative Analysis of Team Communication with a Clinical Texting System at a Midwestern Academic Hospital,” is a collaborative effort of health services researchers, clinicians and hospital administrators.

In addition to Lee, it was conducted by Monica Huffman, BS, Marianne Matthias, PhD, April Savoy, PhD, and Michael Weiner, MD, MPH, all of the Regenstrief Institute; and Areeba Kara, MD, Bethany Radecki, BSN, MSN, and Jason T. Schaffer, MD, all of IU Health.