Pilot Communication Matrix Study

Introduction: Effective communication methods is foundational to clinical practice. Secure messaging systems such as secure chat are tools allowing bidirectional communications with the ability to engage directly to a smart device. This resulted in large volume of messaging leading towards frequent clinician interruptions with potential for medical errors. Without appropriate safeguards, unread messages or interruptions while performing tasks may lead to patient harm. Communication errors impact quality of care with Joint Commission on Accreditation of Healthcare citing miscommunication failures as foci of sentinel events (The Joint Commission, 2024). The study purpose is to evaluate implementation of a communication matrix within an organization that sends out one million secure chat notifications per month.


Methods: 104 clinicians participated in an observational study in the ICU of a community-based healthcare system. A communication matrix introduced to ICU RNs, advanced practice providers, and physicians. Health information technology provided access to secure chat messages including clinician type, message content, number of participants. Messages stratified based on pre-designed communication matrix defining message appropriate or inappropriate. Secure chat data collected for nine weeks. Anonymous pre-post survey sent to all clinicians.


Results: The study found a 12% decrease in total daily messages sent and a 60.47% decrease in inappropriate messages Clinicians rated in person as their preferred method of communication. Most chat conversations reviewed were dyadic with a message mean of 88 to 80 with no significant change in number of conversations including 3 or more participants.


Conclusions: At the time when electronic messaging is part of everyday life, thus, intuitive, clinician education on appropriate utilization communication tools including secure chat message is imperative to safe care. There was a decrease in inappropriate secure chat messaging. This study did not examine the relationship between medical errors or near misses and secure chat communication patterns. Limited data extraction capabilities during this study were related to a large informatics renovation project within the organization during study. Data on changes in secure chat utilization by provider type was not available.