Ryan Sean P, Schwartz Andrew M, Jiranek William A, Seyler Thorsten M, Bolognesi Michael P, Wellman Samuel S
Division of Adult Reconstruction, Department of Orthopaedic Surgery, Duke Health, Durham, North Carolina.
J Arthroplasty. 2025 Jun 24. doi: 10.1016/j.arth.2025.06.069.
Patients are frequently encouraged to send messages to providers 'in-baskets" electronically in the medical record. In recent years, medicine has seen a dramatic expansion in the quantity of messages, requiring major administrative time, which is unchecked and overlooked by payors and hospital administrators. We sought to document the volume of the 'in-basket' of a hip and knee arthroplasty group at a single tertiary referral center.
The electronic "in-basket" was retrospectively queried from 2017 to 2024. Each message and reply from the total joint arthroplasty divisional pool was then counted. Subsequently, only patients who ultimately underwent total joint arthroplasty were evaluated. The quantity of hip and knee arthroplasty procedures was also documented during the same time. Data were evaluated using trend lines and Chi-square.
In-basket messages demonstrated an unparalleled expansion from 7,783 messages in 2017 (5,694 from surgical patients) to 105,348 messages in 2024 (71,216 from surgical patients). Although the volume of surgical cases nearly doubled during the same time period, the quantity of messages escalated by a factor of 13 (P < 0.01). Of the patients, 20% accounted for 59.2% of all messages.
To our knowledge, the exponential growth of in-basket messages in a contemporary academic arthroplasty group has not previously been documented in the literature. This demonstrates an insurmountable and uninhibited growth of a new clinician practice obligation that has no finite upper limit. Alternative models, including technology-based solutions and/or compensating dedicated time for these messages, will imminently be a necessity given the current trend.
患者经常被鼓励通过电子方式在病历中向医疗机构的“收件篮”发送信息。近年来，医疗领域的信息数量急剧增加，需要大量行政时间，而这一情况未得到支付方和医院管理人员的审查与重视。我们试图记录一家三级转诊中心髋膝关节置换术团队的“收件篮”信息数量。
对2017年至2024年的电子“收件篮”进行回顾性查询。然后统计全关节置换科汇总的每条信息及回复。随后，仅对最终接受全关节置换术的患者进行评估。同时还记录了同一时期髋膝关节置换手术的数量。使用趋势线和卡方检验对数据进行评估。
“收件篮”信息呈现出前所未有的增长，从2017年的7783条信息（其中5694条来自手术患者）增至2024年的105348条信息（其中71216条来自手术患者）。尽管同期手术病例数量几乎翻倍，但信息数量增长了13倍（P < 0.01）。其中20%的患者发送了所有信息的59.2%。
据我们所知，当代学术性关节置换术团队中“收件篮”信息的指数级增长此前在文献中尚未有记载。这表明一种新的临床医生工作负担出现了不可阻挡且无上限的增长。鉴于当前趋势，包括基于技术的解决方案和/或为处理这些信息补偿专门时间在内的替代模式将很快成为必要。
