Inpatient Communication Networks: Leveraging Secure Text-Messaging Platforms to Gain Insight into Inpatient Communication Systems.

Abstract

This study attempts to characterize the inpatient communication network within a quaternary pediatric academic medical center by applying network analysis methods to secure text-messaging data. We used network graphing and statistical software to create network models of an inpatient communication system with secure text-messaging data from physicians, nurses, and other ancillary staff in an academic medical center. Descriptive statistics about the network, users within the network, and visualizations informed the team's understanding of the network and its components. Analysis of messages exchanged over approximately 23 days revealed a large, scale-free network with 4,442 nodes and 59,913 edges. Quantitative description of user behavior (messages sent and received) and network metrics (i.e., importance of nodes within a network) revealed several operational and clinical roles both sending and receiving > 1,000 messages over this time period. While some of these nodes represented expected "dispatcher" roles in our inpatient system, others occupied important frontline clinical roles responsible for bedside clinical care. Quantitative and network analysis of secure text-messaging logs revealed several key operational and clinical roles at risk for alert fatigue and information overload. This analysis also revealed a communication network highly reliant on these key roles, meaning disruption to these individuals or their workflows could lead to dysfunction of the communication network. While secure text-messaging applications play increasingly important roles in facilitating inpatient communication, little is understood about the impact these systems have on health care providers. Developing methods to understand and optimize communication between inpatient providers might help operational and clinical leaders to proactively prevent poorly understood pitfalls associated with these systems and build resilient and effective communication structures.