Secure Messaging Use and Wrong-Patient Ordering Errors Among Inpatient Clinicians

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Use of secure messaging for clinician-to-clinician communication has increased exponentially over the past decade, but its association with clinician work is poorly understood. To investigate the association between secure messaging use and wrong-patient ordering errors. This cohort study included inpatient attending physicians, trainee physicians, and advanced practice practitioners (APPs) from 14 academic and community hospitals. Secure messaging volume was assessed over a 3-month period (February 1 to April 30, 2023). Secure messaging volume per clinician-day, measured as the count of secure messages sent and received by a clinician on a given clinician-day. Retract-and-reorder events were used to identify wrong-patient ordering errors, and the presence of any retract-and-reorder event on a clinician-day was the primary outcome. Multilevel logistic regression was used to examine the association between secure messaging volume and wrong-patient ordering errors after adjusting for clinician age, sex, patient load, order volume, and clinical service. A total of 3239 clinicians (median [IQR] age, 37 [32-46] years; 1791 female [55.3%]; 1680 attending physicians [51.2%], 560 trainee physicians [17.3%], and 999 APPs [30.8%]) with 75 546 clinician-days were included. Median secure messaging volume was 16 (IQR, 0-61) messages per day. Retract-and-reorder events were identified on 295 clinician-days (0.4%). Clinicians with secure messaging volume at the 75th percentile had a 10% higher odds of wrong-patient ordering errors compared with those at the 25th percentile (odds ratio [OR], 1.10; 95% CI, 1.01-1.20). After stratifying by clinician role, the association between secure messaging and wrong-patient ordering errors was observed only for attending physicians (OR, 1.20; 95% CI, 1.02-1.42) and APPs (OR, 1.18; 95% CI, 1.00-1.40). In this cohort study of inpatient clinicians, higher daily secure messaging was associated with increased odds of wrong-patient ordering errors. Although messaging may increase cognitive load and risk for wrong-patient ordering errors, these results do not provide conclusive evidence regarding the direct impact of secure messaging on errors, as increased messaging may also reflect greater care coordination, increased patient complexity, or communication of the presence of a wrong-patient ordering error.