Date of Degree
Fall 2025
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Brandee Temmis, DNP, MSN, RN, NE-BC
Second Advisor
Claudette Chin, PhD, APRN
Abstract
Problem: Inefficiencies in patient portal secure messaging between providers and patients in a large primary care practice led to delayed resolution times, averaging 5.6 days per message. Most messages were closed by physicians or advanced practice providers, resulting in imbalanced workload distribution, increased provider burden, and reduced communication efficiency. The lack of standardized guidelines for message use, character limits, or triage processes contributed to workflow disruptions, a diminished patient experience, and unreimbursed provider time.
Aim of the Project: The aim of the project was to reduce average portal message closure times by at least 38% through the implementation of standardized communication protocols, role-based triage, and patient education to enhance communication efficiency while promoting equitable workload distribution.
Review of the Evidence: Evidence supports that structured communication processes, role differentiation, and patient guidance improve efficiency, reduce provider burnout, and enhance patient engagement. Team-based triage workflows and standardized portal guidelines may reduce delays, promote equity in task delegation, and enhance continuity of care.
Project Design: The quality improvement (QI) initiative used Plan-Do-Study-Act (PDSA) cycles within the framework of the OhioHealth Change Management Model to guide iterative improvements. The American Medical Association (AMA) STEPS Forward® toolkit informed interventions. Weekly run and control charts monitored outcomes, process, and balancing measures to ensure safe and effective adoption.
Intervention: Interventions included reducing patient message character limits to 500, distributing patient-facing portal use guidelines, and implementing a role-based team triage system with message categorization, with staff training on message maturation.
Significant Findings/Outcomes: The project achieved an average reduction in time from baseline over 12 weeks of 45%. Workload redistribution improved, but it did not achieve full equity. There was no increase in unresolved messages, confirming interventions did not negatively affect care.
Implications for Nursing: Structured workflows and standardized protocols may reduce inefficiencies and improve the timeliness of communication. Sustaining improvements requires continued monitoring, as well as provider and patient education. The project supports the AACN DNP Essentials and aligns with the Institute for Healthcare Improvement’s Triple Aim by enhancing patient experience, advancing communication efficiency, and reducing provider burden.
Recommended Citation
Fitzpatrick, Tanya M., "Improving Patient Portal Messaging Workflow" (2025). Doctor of Nursing Practice (DNP) Scholarly Project. 42.
https://fuse.franklin.edu/dnp-project/42
Rights
Copyright, all rights reserved
