Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Effective communication in the emergency department (ED) is essential for safe patient care. Electronic health record (EHR)-integrated secure messaging may improve communication workflows, but limited evidence exists comparing clinician satisfaction across modalities in the ED. This study evaluated physician satisfaction with an EHR-integrated secure messaging tool compared to existing communication methods for non-emergent communication.

Methods: We conducted an electronic pre-post survey study at an urban academic ED following implementation of an EHR-integrated secure messaging tool in October 2024. The primary outcome was overall communication satisfaction pre-post implementation. We also compared nursing communication satisfaction and repeat consult order proportions. Survey domains (ease of use, efficiency, timeliness, clarity, overall satisfaction) were graded using a four-point forced-choice Likert scale.

Results: Response rates were 35% (33/95) pre-implementation and 36% (34/95) post-implementation. Although face-to-face communication maintained superior clarity ratings, secure chat received significantly higher overall satisfaction than phone communication (median 3 [IQR 3–4] vs 2 [2–3], P < .001) and higher ratings than the existing consult workflow across all domains (all P ≤ .03). Overall nursing communication satisfaction shifted toward higher scores post-implementation (median 3 [3–4] vs 3 [2–3], P = .03). Repeat consult order proportion decreased from 22% to 18% (risk difference, −3.5%; 95% CI, −4.5% to −2.5%; P < .001).

Conclusion: Electronic health record-integrated secure messaging demonstrated high user satisfaction among emergency physicians and may reduce repeat consultant communications. Secure chat provides a complementary communication channel in the ED setting.