Abstract
Background Hospitals across the country are investing millions of dollars to adopt new Health
Insurance Portability and Accountability Act (HIPAA)-compliant secure text messaging
systems. However, in nearly all cases, these implementations are occurring without
evaluation of their impact on patient care.
Objective To evaluate perceived impact on patient care and workflow of new text messaging system
implemented in obstetrics at Yale-New Haven Hospital and to inform guidelines for
future implementations in emergent settings.
Methods A new HIPAA-compliant texting system was implemented in obstetrics in 2016. Before
implementation of the new system, residents and nurses were surveyed on perceived
effect of communication system (pagers with text receiving, service mobile phones,
personal cell phones) on clinical workflow and patient care using 5-point Likert scale
and open-ended questions. Following roll-out (1 and 6 months), both teams were surveyed
with same questions. Results were compared using Wilcoxon–Mann–Whitney test (0–1 months
and then 0–6 months). Open-ended question results were qualitatively compared for
recurrent unifying themes.
Results In both nursing and resident domains, 1 month after implementation, the new communication
system was perceived to significantly improve efficiency and patient care across all
metrics. After 6 months, this effect decayed in nearly all categories (including efficiency,
real-time communication, and knowledge of covering provider). The exception was nurse's
knowledge of which resident to contact and resident's timely evaluation of patient,
for which we observed sustained improvements. System shortcomings identified included
interrupted connection (i.e., dropped calls), dysfunctional and inaccurate alert system,
and unclear identification of the covering provider.
Conclusion A new text-messaging–based communication system may improve efficiency and patient
care in emergent settings, but system shortcomings can substantially erode potential
benefits over time. We recommend implementers evaluate new systems for a set of specific
functional requirements to increase probability of sustained improvement and decrease
risk of poor patient outcomes.
Keywords
text messaging - smart phone - hospital system - obstetrics
