Association Between Conversational Multitasking and Clinician Work Behaviors at a Large US Health Care System: Cohort Study

Background: Clinical communication is central to the delivery of effective, timely, and safe patient care. The use of text-based tools for clinician-to-clinician communication—commonly referred to as secure messaging—has increased exponentially over the past decade. The use of secure messaging has a potential impact on clinician work behaviors, workload, and cognitive burden. Objective: The objective of this study is to investigate the relationship between conversational multitasking—engaging in multiple concurrent, text-based secure messaging conversations—and clinician workload and cognitive burden for inpatient care. Methods: This observational cohort study included attending physicians, trainee physicians, and advanced practice providers who worked in an inpatient setting at 14 academic and community hospitals affiliated with a large academic medical center in the United States 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 electronic health record (EHR; EHR time) and number of switches between patient charts (patient switching) on that workday. Linear mixed-effect models were used to measure the association between the maximum number of concurrent secure messaging conversations, EHR time, and patient switching on the clinician-day level, after adjusting for covariates (age, gender, total secure messaging volume, patient load, and clinical service assignments). Results: In total, 50,027 clinician-days involving 3232 clinicians (1798 females, 56%; median age 37, IQR 32‐46 y) and 3,556,562 secure messages were included. Median EHR time per day was 307 (IQR 204‐413) minutes, and the median number of patient switches per day was 107 (IQR 60‐176). Compared to clinician-days with no concurrent secure messaging conversations, engaging in a maximum of 2, 3, and 4 or more concurrent secure messaging conversations was associated with an increase in EHR time of 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. Similarly, compared to clinician-days with no concurrent secure messaging conversations, engaging in a maximum of 2, 3, and 4 or more concurrent secure messaging conversations was 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. Stratified analyses showed that trainees experienced the largest increases in EHR time (up to 82.3 min, 95% CI 73.2‐91.4) and patient switches (up to 61.8, 95% CI 54.3‐69.3). Conclusions: Higher levels of conversational multitasking were associated with increased EHR time and more patient switches in a dose-dependent manner. These results suggest that conversational multitasking may be linked with increased clinician workload and cognitive burden, emphasizing the need for guidelines and interventions to streamline secure messaging use in clinical practice.