Perceptions of secure text messaging systems: a cross-sectional survey of hospitalist physicians and advanced practice providers

Introduction Secure text messaging systems (STMS) have largely replaced pagers in inpatient care, yet their operational, workflow, and safety implications in hospital medicine remain poorly understood. We evaluated perceived benefits, challenges, and improvement opportunities related to STMS use among hospitalist physicians and advanced practice providers (APPs) at a large academic medical center.Methods We conducted a cross-sectional, anonymous survey of 133 hospitalist physicians and APPs using Likert-scale items addressing message volume, urgency, platform preference, teamwork, workflow, safety, and well-being, along with open-ended questions. Quantitative data were summarized descriptively, and qualitative responses were analyzed using inductive thematic analysis.Results Sixty-four clinicians responded (48.1% response rate), with 59 complete surveys analyzed. Over half (57.6%) reported using STMS more than pagers, and more than 80% received ≤50 messages daily. Nearly all respondents rated message urgency as low to moderate. While most reported improved multidisciplinary coordination (93.2%) and teamwork (79.7%), 50.9% experienced alarm fatigue or cognitive overload, and 49.2% reported negative effects on well-being. Physicians were more likely than APPs to perceive adverse effects on teamwork (mean 2.71 vs. 3.50, p = 0.006). Qualitative themes included message overload, workflow disruption, and safety risks related to missed or delayed responses. Suggested improvements included urgency labeling, role-based routing, and clearer communication protocols.Conclusion STMS are valued for care coordination but may simultaneously contribute to communication burden, workflow fragmentation, and safety concerns. Hospital systems should adopt governance strategies, including triage tools, training, and role-specific expectations, to optimize digital communication while protecting clinician well-being and patient safety.