JMIR Publications

ABSTRACT

Background:

Secure messaging use for clinical communication has increased exponentially over the past decade. We examined the impact of conversational multitasking on clinician workload and cognitive burden. Method: Participants included attending physicians, trainee physicians, and advanced practice providers who worked in inpatient settings between February and April 2023.The primary exposure was the maximum number of concurrent secure messaging conversations a clinician engaged in during a workday. The co-primary outcomes were total time spent on the EHR, and patient switches. Linear mixed-effect models were used to measure the association between the maximum number of concurrent secure messaging conversations, time spent on the EHR, and patient switching, after adjusting for covariates.

Results:

50,027 clinician-days involving 3,232 clinicians (1,798 females [56%]; mean age=37 [IQR 32–46] years) and 3,556,562 secure messages were included. Compared to having no concurrent conversations, engaging in a maximum of two, three, and four or more concurrent conversations was associated with increases in total time spent on the EHR by 20.3 (95% CI 18.2, 22.4), 38.0 (95% CI 34.9, 41.1), and 54.8 (95% CI 50.6, 58.9) minutes, respectively (all p<0.001). Similarly, compared to having no concurrent conversation, engaging in a maximum of two, three, and four or more concurrent conversations were associated with 14.5 (95% CI 11.3, 17.7), 26.7 (95% CI 21.9, 31.5), and 41.6 (95% CI 35.2, 48.1) additional patient switches, respectively (all p<0.001). Discussion: Findings underscore the potential impact of concurrent conversations on clinician work and emphasize the need for guidelines regarding messaging use in clinical practice.