Standardizing patient-initiated electronic messaging in a high-volume breast center.

Abstract

e13557 Background: Patient-initiated electronic messaging volume has risen nationally, with a 30% annual increase in medical advice requests, 11% yearly rise in telephone messages, and a 157% increase in patient messages following the COVID-19 pandemic. At our large academic Breast Center, MyChart message volume exceeded 100,000 messages annually for three consecutive fiscal years, with over 90% requesting medical advice. High message volume, coupled with inconsistent workflows and unclear patient expectations, negatively impacted care delivery efficiency, staff workload, and patient experience. Methods: We conducted a quality improvement initiative to optimize patient education and standardize InBasket message handling for clinical care messages; non-clinical messages (e.g., scheduling) were excluded. Two objectives were targeted: (1) improving patient MyChart education and expectations and (2) standardizing InBasket message handling workflows. Interventions included updated patient-facing team sheets, standardized MyChart communication guidelines, SmartPhrases reinforcing message expectations, and staff-facing triage guidelines, escalation pathways, standardized response templates, and InBasket handling procedures. Nurses, as frontline managers of InBasket messages, were selected as the survey population. Pre- and post-intervention surveys assessed nursing staff comfort, effectiveness, and workflow clarity. Results: For Objective 1 (nursing satisfaction and ease with patient MyChart education and expectation-setting), survey scores increased from 64% pre-intervention to 72% post-intervention, exceeding the target improvement of 6 percentage points. For Objective 2 (nursing satisfaction and ease with InBasket message handling standardization), scores improved from 88% to 94%, meeting the predefined goal. Staff reported improved clarity regarding appropriate message use, standardized escalation pathways, and reduced unnecessary message back-and-forth. Conclusions: Standardized patient education and structured InBasket workflows improved care delivery efficiency, staff confidence, and satisfaction with electronic message management in a high-volume Breast Center. Clear patient expectations and defined escalation pathways enhanced communication safety and predictability. This scalable care delivery model is applicable to other subspecialty oncology clinics managing high electronic communication burden. Nursing survey: satisfaction and ease pre- and post-intervention. Objective Measure Pre-Intervention Post-Intervention Objective 1 Patient MyChart Education & Setting Expectations 64% 72% Objective 2 InBasket Message Handling Standardization 88% 94%