Using instant messaging applications for consultations in the emergency department: A cross-sectional survey.

Using instant messaging applications for consultations in the emergency department: A cross-sectional survey - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice PLoS One . 2026 Apr 15;21(4):e0347028. doi: 10.1371/journal.pone.0347028 Search in PMC Search in PubMed View in NLM Catalog Add to search Using instant messaging applications for consultations in the emergency department: A cross-sectional survey Sarah S Abdul-Nabi Sarah S Abdul-Nabi 1 Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon Data curation, Writing – original draft, Writing – review & editing Find articles by Sarah S Abdul-Nabi 1, # , Souraya Arabi Souraya Arabi 1 Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon Data curation, Writing – original draft, Writing – review & editing Find articles by Souraya Arabi 1, # , Hind Anan Hind Anan 2 Faculty of Medicine, American University of Beirut, Beirut, Lebanon Writing – original draft Find articles by Hind Anan 2 , Hussein Hijazi Hussein Hijazi 1 Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon Data curation, Methodology, Writing – original draft, Writing – review & editing Find articles by Hussein Hijazi 1 , Hani Tamim Hani Tamim 3 Clinical Research Institute, American University of Beirut, Beirut, Lebanon 4 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia Conceptualization, Formal analysis Find articles by Hani Tamim 3, 4 , Jean-Marie Al Semaani Jean-Marie Al Semaani 2 Faculty of Medicine, American University of Beirut, Beirut, Lebanon Writing – original draft, Writing – review & editing Find articles by Jean-Marie Al Semaani 2 , Maha Makki Maha Makki 3 Clinical Research Institute, American University of Beirut, Beirut, Lebanon Data curation, Formal analysis Find articles by Maha Makki 3 , Afif Mufarrij Afif Mufarrij 1 Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon Conceptualization, Data curation, Methodology, Project administration, Supervision, Validation Find articles by Afif Mufarrij 1, * Editor: Li V Yang 5 Author information Article notes Copyright and License information 1 Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon 2 Faculty of Medicine, American University of Beirut, Beirut, Lebanon 3 Clinical Research Institute, American University of Beirut, Beirut, Lebanon 4 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia 5 Brody School of Medicine at East Carolina University: East Carolina University Brody School of Medicine, UNITED STATES OF AMERICA ✉ * E-mail: [email protected] Competing Interests: The authors have declared that no competing interests exist. # Contributed equally. Roles Sarah S Abdul-Nabi : Data curation, Writing – original draft, Writing – review & editing Souraya Arabi : Data curation, Writing – original draft, Writing – review & editing Hind Anan : Writing – original draft Hussein Hijazi : Data curation, Methodology, Writing – original draft, Writing – review & editing Hani Tamim : Conceptualization, Formal analysis Jean-Marie Al Semaani : Writing – original draft, Writing – review & editing Maha Makki : Data curation, Formal analysis Afif Mufarrij : Conceptualization, Data curation, Methodology, Project administration, Supervision, Validation Li V Yang : Editor Received 2025 Sep 3; Accepted 2026 Mar 26; Collection date 2026. © 2026 Abdul-Nabi et al This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. PMC Copyright notice PMCID: PMC13082625  PMID: 41984919 Abstract Study objective This study investigates how consultants and consultees use Instant Messaging Applications (IMAs) during Emergency Department (ED) consultations, examining their attitudes toward these tools and assessing perceptions of existing consultation methods and the perceived need for system improvements. Methods A cross-sectional study was conducted among clinicians involved in Emergency Department consultations at the American University of Beirut Medical Center, Lebanon. Participants completed an online questionnaire assessing their demographics, consultation patterns, IMAs usage, and opinions on consultation modalities. The recruitment period was from 13/11/2023–08/11/2024. Results A total of 120 participants were included (65 consultants, 55 consultees). Consultants were significantly older than consultees (28.7 ± 3.4 vs. 26.6 ± 1.91 years, p < 0.001). While all consultees were residents, 64.6% of consultants were residents and 35.4% were fellows (p < 0.001). All participants reported using smartphones when on call (100%). IMAs were the most preferred consultation method overall (48.3%), followed by smartphone calls (32.5%). Consultants favored smartphone calls significantly more than consultees (49.2% vs. 12.7%, p < 0.001), whereas consultees preferred workstation phone calls (30.9% vs. 0%, p < 0.001). WhatsApp was the dominant IMA used (98.9%). During night shifts, consultants demonstrated a significantly greater reliance on smartphone calls than consultees (84.6% vs. 63.6%, p = 0.008). IMAs were among the most frequently used methods during both day and night calls (80% vs. 65.2%), and two-thirds of participants (63.7%) reported concerns regarding legal implications and the need for improved consultation tools. Conclusion The findings highlight the need for structured and secure digital solutions to optimize communication between healthcare teams. With IMAs increasingly embedded in ED consultations, future work should focus on developing dedicated and potentially AI-supported platforms that enhance efficiency, documentation, and data security in clinical communication. Introduction The integration of mobile devices into various professional fields, including healthcare, has transformed medical practice and education. Currently, the majority of medical workers own smartphones (SP) they use often in their clinical routines [ 1 , 2 ]. In fact, a study by Boruff et al. revealed that 93.6% of medical students and residents accessed medical resources and applications on their mobile devices [ 2 ]. While only 83 healthcare applications were documented back in 2011 [ 3 ], continuous advancements in technology have magnified this number, highlighting the growing reliance on mobile tools in healthcare practice. SP use by healthcare providers significantly enhances clinical decision-making, patient outcomes, and satisfaction, illustrating its potential to improve healthcare quality and efficiency [ 1 , 3 – 5 ]. Physicians frequently utilize smartphones for oral (56.4%) and written (38.9%) communication, as they find them more efficient than the traditional pagers [ 1 , 9 ]. Studies have shown that mobile devices facilitate faster and more reliable communication, reducing delays in decision-making, and minimizing the risk of medical errors [ 6 – 9 ]. In particular, WhatsApp has gained widespread use in Emergency Departments (EDs) for text messaging, voice notes, and multimedia sharing [ 10 ]. It has considerably reduced the patients’ length of stay, with a median difference of 30 minutes compared to the standard telephone communication [ 11 ]. At the American University of Beirut Medical Center (AUBMC), mobile devices are widely adopted by healthcare providers. In a study conducted at AUBMC, all ED personnel reported owning a mobile device, with most reporting using medical applications in their clinical practice. The majority agreed that mobile devices improved communication and patient care, although fewer felt these tools enhanced teamwork within the department [ 12 ]. Instant Messaging Applications (IMAs) such as WhatsApp were widely adopted, though it remains difficult to clearly differentiate between clinical and personal use [ 12 , 13 ]. In the Emergency Department, consultations are a critical component of patient management and typically involve rapid information exchange between ED-based clinicians and consulting services [ 14 ]. Consultation requests are commonly initiated by ED teams and may include verbal communication, written documentation, or informal messaging to convey clinical details, urgency, and preliminary assessments. Given the time-sensitive and high-acuity nature of ED care, efficient communication during consultations is essential to support timely decision-making and coordination between teams. However, variability in communication modalities and practices may influence the clarity, efficiency, and reliability of information transfer during the consultation process [ 15 ]. Given the critical role of communication in the ED, where response rates and time are essential, this study aims to investigate how IMAs are used when consulting with medical professionals, exploring their attitudes towards these applications, and identifying areas for improvement in communication practice. Methodology Study design and setting This cross-sectional questionnaire-based study was conducted in the Emergency Department at the American University of Beirut Medical Center (AUBMC). Data were collected from 120 ED-based trainees (consultees-55) and residents and fellows from consulting services (consultants-65) between 13/11/2023 and 08/11/2024. AUBMC is an academic tertiary care hospital, handling approximately 55,000 ED visits each year. The ED is staffed by a combination of physicians trained in Emergency Medicine (EM) and experienced practitioners with substantial EM expertise. The EM Residency Program at AUBMC was started in June 2012 as a four-year training program, with an average of five residents per year. In addition to EM residents, residents from other specialties as well as medical students in their fourth year also rotate through the ED as part of their training. Consultations play a crucial role in patient management in the ED. The ED conducts approximately 18,300 consultations annually, averaging around 50 per day, with varying levels of acuity, ranging from minor injuries to critical conditions requiring immediate intervention. Previously, AUBMC relied on pagers primarily for alert-based communication, such as notifying on-call providers of consultation requests, but later transitioned to a secure, institution-approved electronic system for consultation order placement. Pagers use remain limited within certain services and workflows. In addition, AUBMC provides free Wi-Fi access for staff. The consultation process begins with an ED trainee evaluating the patient and presenting the case to the ED attending physician, who oversees the initial assessment and workup. If consultation from another service is required, the ED team places a consultation order in the Electronic Medical Record (EMR) to formally document the request. However, this order does not generate an automatic notification to the consulting team. Therefore, the ED team directly contacts the on-call resident or fellow from the consulting service to communicate the patient information and the clinical question requiring consultation. The consultant subsequently evaluates the patient and discusses the assessment and management plan with the ED team ( Fig 1 ). Fig 1. Consultation process flow chart. Open in a new tab As per AUBMC policy, if there is no response after two contact attempts within 10 minutes, the ED attending escalates the request to the consultant service attending-on-call, who becomes responsible for ensuring a prompt response. Selection of participants The study population includes two groups: Consultees and Consultants Consultees (covering ED shifts) Consultants Residents (Emergency Medicine residents and moonlighters (licensed physicians who are not enrolled in a residency or fellowship program at the time of employment and who cover Emergency Department shifts during a transitional “gap year,” typically before starting residency or before entering fellowship.), as well as residents rotating in the ED from various specialties: Pediatrics, Internal Medicine, Family Medicine, Otorhinolaryngology, Anesthesiology, Radiology, Obstetrics and Gynecology, Psychiatry and Medical Students. • Residents: Specialties including Anesthesiology, Dermatology, Radiology, Neurology, Ophthalmology, Otorhinolaryngology, Psychiatry, Surgery (Neurosurgery, General Surgery, Critical Care, Urology, Orthopedics, Plastics), and Obstetrics and Gynecology) • Clinical fellows consulted by ED residents, moonlighters, or students. Subspecialties such as Endocrinology, Gastroenterology, Nephrology, Pulmonology, Infectious Diseases (adult & pediatric), Hematology/Oncology (adult & pediatric), Intensive Care (adult & pediatric), Cardiology (adult & pediatric), and Pediatric Neurology). Open in a new tab Inclusion criteria for consultees are all medical students and residents as well as moonlighters covering shifts in the ED. Inclusion criteria for consultants are all residents and clinical fellows consulted by ED residents. There were no exclusion criteria, participation was open to all eligible individuals who consent to take part. Attending physicians were not included because they supervise, approve, or decline consultations but do not directly engage in the communication process. In the study, participants are categorized as follow: Surgical specialties: General Surgery, Orthopedics, Neurosurgery, OBGYN, Ophthalmology, Otorhinolaryngology Acute non-surgical specialties with potential procedures: Radiology, Neurology, Anesthesia, Plumo/ICU, Cardiology, Emergency Medicine Acute non-surgical specialties with NO potential procedures: Psychiatry, Pathology, Family Medicine, Nephrology, Gastroenterology, Infectious disease, Endocrinology, Pediatrics, Internal medicine Junior Residents: House Physician, Post graduate year (PGY) 1 & PGY2 Senior Residents: PGY3,4,5,6 Data collection tool (questionnaire) A cross-sectional survey was sent by email to residents and fourth-year medical students working in the Emergency Department (consultees), and to residents and fellows from consulting services (consultants) at AUBMC. Attending physicians were not included in the survey as the study focused on trainees who most frequently initiate and receive consultation requests. The recruitment period was from 13/11/2023–08/11/2024. A total of 120 participants completed the questionnaire, including 55 consultees and 65 consultants. Data collection procedure The questionnaire was initially piloted and reviewed by 2–3 consultants and consultees to ensure clarity and relevance before it was distributed. The survey was in English, as all participants demonstrate English proficiency prior to their positions. It explored participant demographics, consultation practices and communication modalities, as well as perceptions related to efficiency, privacy, and areas for improvement in consultation processes. Two tailored survey versions were used: Consultees’ Survey (Designed for medical students and residents working in the ED) and Consultants’ Survey (Addressed to residents and fellows serving as consultants). Both versions followed similar themes with minor role-specific differences. A copy of the questionnaire developed for this study has been provided as S1 File . Ethical consideration Approval was granted by the Institutional Review Board under protocol number: SBS-2023–0009. This study poses minimal risk to participants, as all survey responses are anonymous and confidential. Participants provided informed online consent before completing the survey. Participation was voluntary, with no identifying information collected. Additional information regarding the ethical, cultural, and scientific considerations specific to inclusivity in global research is included in the Supporting Information ( S2 File ). Data analysis Data collection was extracted through SPSS. The Statistical Package for the Social Sciences (SPSS) version 25.0 was used for data cleaning, management, and analysis. Descriptive statistics were presented as mean ± standard deviation (SD) for continuous variables. Categorical data were reported as frequencies and percentages. In the bivariate analysis, the relationships between participant roles (consultant vs consultee) and other categorical variables was analyzed using Pearson’s Chi-square test. Whereas Student’s t-test was used for the association with continuous variables. The statistical significance was set at p-value < 0.05. Results Table 1 presents the Demographics and Professional Characteristics (Residency Program and Level) of Consultants and Consultees. The study included a total of 120 participants, 40% of which were male. These consisted of 65 consultants and 55 consultees. The mean age of the consultants was significantly higher than that of the consultees (28.7 ± 3.4 vs 26.6 ± 1.9 years, p < 0.001). The distribution of participants across residency programs also showed significant variation ( p < 0.001). While 25.0% of consultants belonged to surgical specialties, the remaining participants were distributed across acute non-surgical specialties with potential procedures (37.5% consultants vs. 35.8% consultees) and acute non-surgical specialties with no potential procedures (37.5% consultants vs. 37.7% consultees). In terms of residency level, junior residents constituted 41.8% of consultees, which is significantly higher than that of consultants (41.8 vs 23.1%, p < 0.001). Conversely, senior residents made up a greater proportion of consultants (56.9%) compared to consultees (32.7%). 20% of consultants were fellows and students accounted for 25.5% of consultee. A significant difference was found in the shift duration when on call where consultants had a longer shift than consultees (23.1 ± 7.7 hours vs. 9.0 ± 1.9 hours, p < 0.001). Table 1. Demographics and Professional Characteristics (Residency Program and Level) of Consultants and Consultees. Total N = 120 Consultant N = 65 Consultees N = 55 P-value Gender Male 48 (40.0%) 29 (44.6%) 19 (34.5%) 0.26 Age Mean ± SD 27.7 ± 3.0 28.7 ± 3.4 26.6 ± 1.9 <0.001 Position Resident 97 (80.8%) 42 (64.6%) 55 (100.0%) <0.001 Fellow 23 (19.2%) 23 (35.4%) 0 (0.0%) Program Surgical specialties * 16 (13.7%) 16 (25.0%) 0 (0.0%) <0.001 Acute non-surgical specialties with potential procedures ** 43 (37.8%) 24 (37.5%) 19 (35.8%) Acute non-surgical specialties with NO potential procedures *** 44 (37.6%) 24 (37.5%) 20 (37.7%) Students 14 (12.0%) 0 (0.0%) 14 (26.4%) Year Junior Residents ^ 38 (31.7%) 15 (23.1%) 23 (41.8%) <0.001 Senior Residents ^^ 55 (45.8%) 37 (56.9%) 18 (32.7%) Fellows 13 (10.8%) 13 (20.0%) 0 (0.0%) Students 14 (11.7%) 0 (0.0%) 14 (25.5%) Shift duration when on call (in hours) Mean ± SD 16.6 ± 9.1 23.1 ± 7.7 9.0 ± 1.9 <0.001 Open in a new tab * Surgical specialties: General Surgery, Orthopedics, Neurosurgery, OBGYN, Ophthalmology, Otorhinoloryngology. ** Acute non-surgical specialties with potential procedures: Radiology, Neurology, Anesthesia, Plumo/ICU, Cardiology, Emergency Medicine. *** Acute non-surgical specialties with NO potential procedures: Psychiatry, Pathology, Family Medicine, Nephrology, Gastroenterology, Infectious disease, Endocrinology, Pediatrics, Internal medicine. ^ Junior Residents: House Physician, PGY1 & PGY2. ^^ Senior Residents: PGY3,4,5,6. Table 2 presents General Information Related to SP Usage and Consultation Preferences Among Consultants and Consultees. All (100%) participants reported having a SP and using it while on call or duty. Additionally, 16.7% of participants reported that their smartphone was used by another team member for consultation-related communication, more frequently among consultees (23.6%) than consultants (10.8%) (p = 0.06). The preferred method of consultation for consultees was IMAs (48.3%, p < 0.001) while consultants preferred phone calls on SP (49.2%). In fact, both groups favored using IMAs like WhatsApp, with 44.6% of consultants and 52.7% of consultees indicating this preference. While 30.9% of consultees preferred using workstation phone calls, none of the consultants selected this method. On the other hand, consultants preferred using a phone call on their personal smartphones (49.2%), significantly more than consultees (12.7%, p < 0.001). Table 2. General Information Related to smartphones (SP) Usage and Consultation Preferences Among Consultants and Consultees. Total N = 120 Consultant N = 65 Consultees N = 55 P-value Ownership of a SP Yes 120 (100.0%) 65 (100.0%) 55 (100.0%) – Use of SP when on call/duty Yes 120 (100.0%) 65 (100.0%) 55 (100.0%) – Smartphone used by another team member Yes 20 (16.7%) 7 (10.8%) 13 (23.6%) 0.06 Preferred method of consultation IMA 58 (48.3%) 29 (44.6%) 29 (52.7%) <0.001 Phone call on SP 39 (32.5%) 32 (49.2%) 7 (12.7%) Workstation phone call 17 (14.2%) 0 (0.0%) 17 (30.9%) Pager 6 (5.0%) 4 (6.2%) 2 (3.6%) Open in a new tab Table 3 presents Consultation Patterns among Consultants and Consultees During Day and Night Calls. For pager use, consultees were significantly more likely to use pagers compared to consultants during both day calls (32.7% vs. 15.6%, p = 0.03) and night calls (29.1% vs. 12.3%, p = 0.02). Similarly, the use of workstation phone calls differed significantly between the two groups. During day calls, consultees relied more on workstation phone calls compared to consultants (81.8% vs 56.9%, p = 0.003). This difference was even more pronounced during night calls, where 80.0% of consultees used workstation phone calls compared to only 49.2% of consultants ( p < 0.001). Regarding phone calls made via SP, a significant difference was observed during night calls, with a higher proportion of consultants using this method compared to consultees (84.6% vs. 63.6%, p = 0.008). Although the overall use of IMA did not significantly differ between consultants and consultees during day or night calls. Table 3. Consultation Patterns among Consultants and Consultees during Day and Night Call. Total N = 120 Consultant N = 65 Consultees N = 55 P-value Pager Day call 28 (23.5%) 10 (15.6%) 18 (32.7%) 0.03 Night call 24 (20.0%) 8 (12.3%) 16 (29.1%) 0.02 Workstation phone call Day call 82 (68.3%) 37 (56.9%) 45 (81.8%) 0.003 Night call 76 (63.3%) 32 (49.2%) 44 (80.0%) <0.001 Phone call from SP Day call 93 (77.5%) 53 (81.5%) 40 (72.7%) 0.25 Night call 90 (75.0%) 55 (84.6%) 35 (63.6%) 0.008 IMA Day call 96 (80.0%) 53 (81.5%) 43 (78.2%) 0.65 Night call 75 (62.5%) 38 (58.5%) 37 (67.3%) 0.32 Open in a new tab Table 4 presents Usage Patterns and Frequency of IMA for Consultations among Consultants and Consultees. WhatsApp was the most frequently used Instant Messaging Application IMA for consultations, with nearly all participants (98.9%) relying on it, and no significant differences observed between consultants and consultees (p = 0.33). Text messaging was the most used consultation tool via IMA, with 95.6% of participants favoring it, and no significant difference between consultants and consultees (97.9% vs 93.2%, p = 0.28). Voice messages were also widely used (82.4%) by both consultants and consultees. Moreover, images were used by consultees more than consultants (63.6% vs 42.6%, p = 0.04). The average number of consultations conducted via IMA per call or duty was slightly higher among consultees compared to consultants though this difference was not statistically significant (6.45 ± 7.42 vs. 4.94 ± 4.21, p = 0.23). Regarding language use in IMA consultations, English was the predominant language for both groups (80.2%), with no significant variation between consultants and consultees (p = 0.33). Table 4. Usage Patterns and Frequency of IMA for Consultations among Consultants and Consultee. Total N = 120 Consultant N = 65 Consultees N = 55 P-value Most used IMA WhatsApp 90 (98.9%) 46 (97.9%) 44 (100.0%) 0.33 Other 1 (1.1%) 1 (2.1%) 0 (0.0%) Most USED method Text Message 87 (95.6%) 46 (97.9%) 41 (93.2%) 0.28 Image 48 (52.7%) 20 (42.6%) 28 (63.6%) 0.04 Video 11 (12.1%) 6 (12.8%) 5 (11.4%) 0.84 Voice Message 75 (82.4%) 42 (89.4%) 33 (75.0%) 0.07 Average number of IMA consultations per call/shift Mean ± SD 5.7 ± 6 4.9 ± 4.2 6.4 ± 7.4 0.23 Language used via IMA English 73 (80.2%) 36 (76.6%) 37 (84.1%) 0.33 Arabic 3 (76.6%) 3 (6.4%) 0 (0.0%) Chat language (Arabic written in English letters) 15 (16.5%) 8 (17%) 7 (15.9%) Open in a new tab Table 5 presents participants opinion regarding the use of IMA for consultations. In terms of trust, text messages remained the most trusted tool (70.3%). However, consultants were significantly more likely to trust image-based consultations than consultees (29.8% vs 4.5%, p = 0.002). On the other hand, voice messages were trusted by 40.4% of consultants but only 8.6% of consultees, reflecting a significant difference (p = 0.001). Voice messages were reported as the most distrusted tool by 44.0% of participants, followed by images (24.2%), with no significant differences between groups. When rating the utility of IMA-based consultations on a range of 0% (Never) to 100% (Always), participants rated IMA as fast (84.4 ± 23.6), easy (87.9 ± 24.0), and accessible (88.5 ± 19.5), with no major differences between groups. However, consultants perceived IMA consultations as significantly more distracting than consultees (58.5 ± 35.1 vs 38.6 ± 33.9, p = 0.007). Table 5. Consultants and Consultees opinion regarding the use of IMA for consultations. Total N = 120 Consultant N = 65 Consultees N = 55 P-value Most TRUSTED method Text Message 64 (70.3%) 35 (74.5%) 29 (65.9%) 0.37 Image 16 (17.6%) 14 (29.8%) 2 (4.5%) 0.002 Video 3 (3.3%) 3 (6.4%) 0 (0.0%) 0.24 Voice Message 22 (26.8%) 19 (40.4%) 3 (8.6%) 0.001 Most DISTRUSTED method Text Message 16 (17.6%) 8 (17.0%) 8 (18.2%) 0.88 Image 22 (24.2%) 15 (31.9%) 7 (15.9%) 0.07 Video 12 (13.2%) 8 (17.0%) 4 (9.1%) 0.26 Voice Message 40 (44.0%) 22 (46.8%) 18 (40.9%) 0.57 Consultation Request through IMA causes any legal problems Yes 58 (63.7%) 31 (66.0%) 27 (61.4%) 0.25 For the below questions: Answers range from 0% (Never) to 100% (Always) Consultation request through IMA is: Fast Percentage 84.4 ± 23.6 84.2 ± 26.0 84.6 ± 21.0 0.93 Easy Percentage 87.9 ± 24.0 87.8 ± 24.9 88.1 ± 23.2 0.95 Reliable Percentage 69.8 ± 26.2 67.5 ± 28.5 72.2 ± 23.6 0.40 Understandable Percentage 75.8 ± 24.8 73.4 ± 25.8 78.4 ± 23.9 0.34 Accessible Percentage 88.5 ± 19.5 87.8 ± 20.1 89.2 ± 19.0 0.73 Professional Percentage 51.1 ± 28.1 50.0 ± 31.3 52.3 ± 24.6 0.70 Convenient Percentage 80.8 ± 24.7 80.8 ± 22.8 80.7 ± 26.9 0.97 Distracting Percentage 48.9 ± 35.7 58.5 ± 35.1 38.6 ± 33.9 0.007 Connection issue delaying consultation via IMA Percentage 23.6 ± 19.8 28.2 ± 22.5 18.8 ± 15.4 0.02 The current Consultation Request Tool is adequate Disagree 19 (17.9%) 10 (18.2%) 9 (17.6%) 0.26 Neutral 39 (36.8%) 24 (43.6%) 15 (29.4%) Agree 48 (45.3%) 21 (38.2%) 27 (52.9%) The current Consultation Request Tool should be improved/more organized Disagree 2 (1.9%) 1 (1.8%) 1 (2.0%) 0.79 Neutral 26 (24.5%) 15 (27.3%) 11 (21.6%) Agree 78 (73.6%) 39 (70.9%) 39 (76.5%) It is necessary to develop an electronic platform or an application exclusively for consultation request Disagree 18 (17.0%) 12 (21.8%) 6 (11.8%) 0.35 Neutral 18 (17.0%) 8 (14.5%) 10 (19.6%) Agree 70 (66.0%) 35 (63.6%) 35 (68.6) Open in a new tab Finally, 45.3% agree that the current consultation process is adequate, while 73.6% believe it should be improved or better organized, and two-thirds (66.0%) agree that an electronic platform or application should be developed for consultations. Discussion The study included 120 participants, with 65 consultants and 55 consultees. Consultants were older than consultees, and while all consultees were residents, 35.4% of consultants were fellows. The participants’ residency programs varied significantly, with consultants more likely to belong to surgical specialties. All participants used SPs while on duty, with Instant Messaging Applications being the most used consultation modality. Consultants favored SP calls, whereas consultees relied more on workstation phone calls. Consultants also had significantly longer shift durations. Consultation patterns varied between day and night shifts, with consultees more likely to use pagers and workstation phone calls, while consultants preferred SP calls, particularly at night. WhatsApp was the most used IMA, and text messaging was the predominant consultation tool. Consultants reported greater trust in image-based and voice message consultations than consultees. Overall, the study highlights significant differences in consultation preferences and communication patterns between consultants and consultees. The study focused on directly comparing consultees and consultants within a single ED system, using two role-specific versions of the same questionnaire. The aim was to capture differences in workflow, preferences, and perceived challenges. Unlike most prior work, which focuses primarily on general smartphone use or single-group assessments, this study differentiates the consultation behavior of ED-based trainees from that of consulting services [ 16 ]. It also incorporates day- versus night-shift communication patterns, perceived trust across multiple IMA modalities, and the impact of shift duration, all features that are rarely examined simultaneously in previous investigations. This dual-group, workflow-specific approach provides a clearer understanding of how consultation dynamics differ across levels of training and service responsibilities within the ED environment. In our study, consultants showed a markedly stronger preference for SP calls compared to consultees, who preferred workstation phone calls. This may be due to differences in workflow and physical location, with consultants often off-site and consultees consistently positioned in the ED [ 18 ]. This difference was even more pronounced during night shifts, when consultants showed a significantly higher preference for SP calls. A likely explanation is that consultants are often covering multiple units or off-site locations during night duty, making direct smartphone communication more practical and responsive than workstation-based methods. This pattern is consistent with prior studies showing that clinicians rely more heavily on mobile phone calls during after-hours or when managing wider geographic responsibilities [ 6 , 19 ]. WhatsApp was the dominant IMA used by nearly all participants, likely because it is universally accessible, familiar, and reliable for rapid clinical communication [ 17 ]. The extensive use of IMAs observed in both groups aligns with earlier studies reporting broad uptake of asynchronous communication tools among clinicians [ 15 ]. In addition, the preference for phone calls aligns with studies noting increased smartphone reliance during longer or more demanding shifts [ 16 ]. Unlike previous work that shows a uniform adoption of WhatsApp [ 13 ], our results demonstrate a more nuanced pattern, with consultants showing greater trust in image-based and voice-message consultations than consultees. This might be due to images offering clearer clinical detail for triage accuracy and voice messages allowing rapid, hands-free communication when consultants are mobile or covering multiple units mechanisms previously described in studies examining remote clinical communication dynamics [ 20 ]. The predominance of text messaging in our sample reinforces earlier observations that asynchronous communication remains a cornerstone of clinical coordination [ 17 , 18 ]. Yet consultants in our study reported more distraction, connection issues, and diagnostic limitations than consultees. Mobile communication has been shown to increase interruptions and workflow disruption among clinicians, especially when they are managing multiple responsibilities across different clinical areas [ 21 ]. In addition, studies on mobile messaging systems report that unstable connections and inconsistent Wi-Fi coverage can undermine communication reliability, particularly for clinicians who move frequently between hospital units [ 22 ]. Diagnostic limitations of remote communication have been documented, with studies showing that text- and image-based exchanges may omit key contextual cues, reducing diagnostic certainty and increasing the risk of misinterpretation in complex assessments [ 23 ]. While IMAs enhance speed and accessibility, they raise concerns regarding confidentiality, documentation, and medico-legal exposure. This echoes prior findings emphasizing inconsistent record-keeping and the absence of standardized guidelines [ 24 ]. Studies in other clinical settings have shown that implementing structured communication tools improves the clarity of consult requests and reduces perceived miscommunication [ 25 ], and that teaching structured methods that enhance the content and clarity of interprofessional referrals [ 26 ]. The results highlight a pressing need for streamlined, secure communication systems capable of integrating clinical data, supporting documentation, and reducing variability across teams. Future research should evaluate how structured digital platforms, potentially incorporating advanced automation or AI-supported triage, could improve workflow reliability, enhance data protection, and standardize communication across consultees and consultants within the ED. Limitations This study has several limitations. First, the cross-sectional design limits the ability to establish causal relationships or assess changes over time. The study is also restricted to a single institution, AUBMC, with a small sample size of only 120 participants, which may limit the generalizability of the findings to other settings or larger, more diverse populations. Furthermore, attending physicians were not included in the participant population, which may affect the comprehensiveness of the findings regarding communication dynamics. In fact, some ED attendings physicians who may opt to contact the attending consultant directly without going through the channel of residents. Moreover, some consultations are conducted in person when a consultant is already present and evaluating another patient. Rather than utilizing formal communication methods such as IMA or phone calls, ED physicians often choose face-to-face interactions with consultants to inform them of additional consults. While this direct interaction facilitates immediate discussion, faster decision-making, and more efficient patient management, it may reduce the potential for delays associated with electronic or phone-based communication. Finally, the study did not explore whether participants had used other mobile applications prior to using the WhatsApp for consultations, which may have influenced their preferences and attitudes toward WhatsApp. Supporting information S1 File. Study questionnaire. Full survey instruments used for consultants and consultees assessing consultation practices and use of instant messaging applications in the emergency department. (DOCX) pone.0347028.s001.docx (67.2KB, docx) S2 File. Inclusivity in global research. Completed PLOS checklist detailing ethical, cultural, and authorship considerations for research conducted at AUBMC. (DOCX) pone.0347028.s002.docx (67.9KB, docx) Data Availability The data underlying this study contain potentially identifiable clinical information and cannot be shared publicly due to institutional and ethical restrictions imposed by the American University of Beirut Medical Center (AUBMC) and its Institutional Review Board. Data access may be requested through the AUB Human Research Protection Program (HRPP) / Institutional Review Board at [email protected] . Requests will be evaluated in accordance with AUB’s data protection and ethical oversight policies. The dataset used in this study is stored securely within the Department of Emergency Medicine at AUBMC. Funding Statement The author(s) received no specific funding for this work. References 1. Maassen O, Fritsch S, Gantner J, Deffge S, Kunze J, Marx G, et al. Future Mobile Device Usage, Requirements, and Expectations of Physicians in German University Hospitals: Web-Based Survey. J Med Internet Res. 2020;22 (12):e23955. doi: 10.2196/23955 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 2. Boruff JT, Storie D. Mobile devices in medicine: a survey of how medical students, residents, and faculty use smartphones and other mobile devices to find information. J Med Libr Assoc. 2014;102 (1):22–30. doi: 10.3163/1536-5050.102.1.006 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 3. Mosa ASM, Yoo I, Sheets L. A systematic review of healthcare applications for smartphones. BMC Medical Informatics and Decision Making. 2012;12:1–31. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 4. Divall P, Camosso-Stefinovic J, Baker R. The use of personal digital assistants in clinical decision making by health care professionals: a systematic review. Health Informatics J. 2013;19 (1):16–28. doi: 10.1177/1460458212446761 [ DOI ] [ PubMed ] [ Google Scholar ] 5. Gaj F, Peracchini M, Passannanti D, Quaresima S, Giovanardi F, Lai Q. Use of telemedicine in the postoperative assessment of proctological patients: a case-control study. Tech Coloproctol. 2023;27 (2):153–8. doi: 10.1007/s10151-022-02723-9 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 6. Wu RC, Morra D, Quan S, Lai S, Zanjani S, Abrams H, et al. The use of smartphones for clinical communication on internal medicine wards. J Hosp Med. 2010;5 (9):553–9. doi: 10.1002/jhm.775 [ DOI ] [ PubMed ] [ Google Scholar ] 7. Soto RG, Chu LF, Goldman JM, Rampil IJ, Ruskin KJ. Communication in critical care environments: mobile telephones improve patient care. Anesth Analg. 2006;102 (2):535–41. doi: 10.1213/01.ane.0000194506.79408.79 [ DOI ] [ PubMed ] [ Google Scholar ] 8. Ortega GR, Taksali S, Smart R, Baumgaertner MR. Direct cellular vs. indirect pager communication during orthopaedic surgical procedures: a prospective study. Technol Health Care. 2009;17 (2):149–57. doi: 10.3233/THC-2009-0540 [ DOI ] [ PubMed ] [ Google Scholar ] 9. O’Connor C, Friedrich JO, Scales DC, Adhikari NKJ. The use of wireless e-mail to improve healthcare team communication. J Am Med Inform Assoc. 2009;16 (5):705–13. doi: 10.1197/jamia.M2299 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 10. Gulacti U, Lok U, Hatipoglu S, Polat H. An analysis of WhatsApp usage for communication between consulting and emergency physicians. J Med Syst. 2016;40 (6):130. [ DOI ] [ PubMed ] [ Google Scholar ] 11. Lok U, Gulacti U. Comparison of secure messaging application (WhatsApp) and standard telephone usage for consultations on Length of Stay in the ED. Appl Clin Inform. 2017;08 (03):742–53. doi: 10.4338/aci-2017-04-ra-0064 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 12. Hitti E, Hadid D, Melki J, Kaddoura R, Alameddine M. Mobile device use among emergency department healthcare professionals: prevalence, utilization and attitudes. Sci Rep. 2021;11 (1):1917. doi: 10.1038/s41598-021-81278-5 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 13. Alameddine M, Soueidan H, Makki M, Tamim H, Hitti E. The Use of Smart Devices by Care Providers in Emergency Departments: Cross-Sectional Survey Design. JMIR Mhealth Uhealth. 2019;7 (6):e13614. doi: 10.2196/13614 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 14. Woloshynowych M, Davis R, Brown R, Vincent C. Communication patterns in a UK emergency department. Ann Emerg Med. 2007;50 (4):407–13. doi: 10.1016/j.annemergmed.2007.08.001 [ DOI ] [ PubMed ] [ Google Scholar ] 15. Brick C, Lowes J, Lovstrom L, Kokotilo A, Villa-Roel C, Lee P, et al. The impact of consultation on length of stay in tertiary care emergency departments. Emerg Med J. 2014;31 (2):134–8. doi: 10.1136/emermed-2012-201908 [ DOI ] [ PubMed ] [ Google Scholar ] 16. Ventola CL. Mobile devices and apps for health care professionals: uses and benefits. P T. 2014;39 (5):356–64. [ PMC free article ] [ PubMed ] [ Google Scholar ] 17. Mars M, Scott RE. WhatsApp in Clinical Practice: A Literature Review. Stud Health Technol Inform. 2016;231:82–90. doi: 10.3233/978-1-61499-712-2-82 [ DOI ] [ PubMed ] [ Google Scholar ] 18. Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors’ use of mobile devices in the clinical setting: a mixed methods study. Intern Med J. 2017;47 (3):291–8. doi: 10.1111/imj.13349 [ DOI ] [ PubMed ] [ Google Scholar ] 19. Payne KFB, Wharrad H, Watts K. Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK): a regional survey. BMC Med Inform Decis Mak. 2012;12:121. doi: 10.1186/1472-6947-12-121 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 20. Nair AA, Afroz S, Ahmed BU, Ahmed UU, Foo CC, Zaidan H, et al. Smartphone Usage Among Doctors in the Clinical Setting in Two Culturally Distinct Countries: Cross-sectional Comparative Study. JMIR Mhealth Uhealth. 2021;9 (5):e22599. doi: 10.2196/22599 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 21. Westbrook JI, Coiera E, Dunsmuir WTM, Brown BM, Kelk N, Paoloni R, et al. The impact of interruptions on clinical task completion. Qual Saf Health Care. 2010;19 (4):284–9. doi: 10.1136/qshc.2009.039255 [ DOI ] [ PubMed ] [ Google Scholar ] 22. Mobasheri MH, King D, Johnston M, Gautama S, Purkayastha S, Darzi A. The ownership and clinical use of smartphones by doctors and nurses in the UK: a multicentre survey study. BMJ Innov. 2015;1 (4):174–81. doi: 10.1136/bmjinnov-2015-000062 [ DOI ] [ Google Scholar ] 23. Deldar K, Bahaadinbeigy K, Tara SM. Teleconsultation and Clinical Decision Making: a Systematic Review. Acta Inform Med. 2016;24 (4):286–92. doi: 10.5455/aim.2016.24.286-292 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 24. Morris C, Scott RE, Mars M. WhatsApp in Clinical Practice-The Challenges of Record Keeping and Storage. A Scoping Review. Int J Environ Res Public Health. 2021;18 (24):13426. doi: 10.3390/ijerph182413426 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 25. Pavitt S, McHugh A, Chi K, Hoang K, Lippner E, Tsai J, et al. Improving Inpatient Consult Communication Through a Standardized Tool. Pediatrics. 2021;147 (5):e20200681. doi: 10.1542/peds.2020-0681 [ DOI ] [ PubMed ] [ Google Scholar ] 26. Marshall S, Harrison J, Flanagan B. The teaching of a structured tool improves the clarity and content of interprofessional clinical communication. Qual Saf Health Care. 2009;18 (2):137–40. doi: 10.1136/qshc.2007.025247 [ DOI ] [ PubMed ] [ Google Scholar ] PLoS One. doi: 10.1371/journal.pone.0347028.r001 Decision Letter 0 Li Yang Li Yang Academic Editor Find articles by Li Yang Author information Copyright and License information Roles Li Yang : Academic Editor © 2026 Li YangLi YangLi YangLi Yang This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. PMC Copyright notice 12 Dec 2025 Dear Dr. Mufarrij, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jan 26 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at [email protected] . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. A letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .... We look forward to receiving your revised manuscript. Kind regards, Li V. Yang, Ph.D. Academic Editor PLOS One Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include a complete copy of PLOS’ questionnaire on inclusivity in global research in your revised manuscript. Our policy for research in this area aims to improve transparency in the reporting of research performed outside of researchers’ own country or community. The policy applies to researchers who have travelled to a different country to conduct research, research with Indigenous populations or their lands, and research on cultural artefacts. The questionnaire can also be requested at the journal’s discretion for any other submissions, even if these conditions are not met.  Please find more information on the policy and a link to download a blank copy of the questionnaire here: https://journals.plos.org/plosone/s/best-practices-in-research-reporting . Please upload a completed version of your questionnaire as Supporting Information when you resubmit your manuscript. 3. Please update your submission to use the PLOS LaTeX template. The template and more information on our requirements for LaTeX submissions can be found at http://journals.plos.org/plosone/s/latex . 4. In the online submission form you indicate that your data is not available for proprietary reasons and have provided a contact point for accessing this data. Please note that your current contact point is a co-author on this manuscript. According to our Data Policy, the contact point must not be an author on the manuscript and must be an institutional contact, ideally not an individual. Please revise your data statement to a non-author institutional point of contact, such as a data access or ethics committee, and send this to us via return email. Please also include contact information for the third party organization, and please include the full citation of where the data can be found. 5. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. 6. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Partly Reviewer #2: Partly ********** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ********** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.--> Reviewer #1: Yes Reviewer #2: Yes ********** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: No ********** Reviewer #1: Very important study that explores a crucial aspect of patient care related to communication across medical teams in the Emergency Departments with consulting services. Abstract: 1. Study objective: a. the use of consultants is confusing here as you state “residents and consultants”. I suggest using it only to refer the teams being consulted and refer to the team doing the consulting as consultee. Your aim then is about how “consultants and consultees” within the ED use IMA etc b. One stated objective is to identify areas for improvement. How is the study designed to identify this? If this is not included in the survey questionnaire, then remove from objective 2. Methods: Need to mention that this is within an ED context. 3. Result: some key results related to perceptions are missing from here. 4. Conclusion: this needs to be supported by the study findings. Use of AI as main part of the conclusion is not supported by findings. Introduction: 1. In general it makes a good argument for increasing usage of mobile devices in health care. Since the study focuses on communication around consultation practices, the background needs a section on that specifically. What are current practices around initiating consultation request and sharing information around the consult between the consulting teams and consultants? This needs to be added, ideally in the ED context if available, given the focus of the study. 2. Authors state that whatsap has “gained widespread use in the ED” , this needs a source/reference 3. In the paragraph about AUBMC, authors state that “all ED personnel owned”. Grammar does not fit here. If this is based on a study, then state “In a study conducted at AUBMC, all personnel reported owning …” 4. Last paragraph related to aims, I suggest remove whatsapp to remain consistent across the article (with abstract). Methods section 1. The study design needs to be better outlined. • This is a cross sectional survey, what type of survey? • Dates conducted • Include who was surveyed 2. Study setting: a. The paragraph relating to how you place consults is important but needs some work: i. What type of communication were pagers used for? ii. What is Webex system? I suggest use of type of communication rather than brand and some description of what that system entails (security, access etc) iii. The statement about free wifi and use of smartphone being more “convenient” sounds like it is an assumption. Suggest to just state that the institution provides free wifi. iv. The paragraph related to consultation process: 1. states that “if a specialist consultation is required”. EM physicians are also specialists. I suggest usage of “if a consultation from another service is required”. 2. The last paragraph is a good description of policy and process and clearer than the paragraph before it where it is not clear whether the ED team contacts the attending consultant or the trainee teams on the consultant service. Figure should reflect that process outlined in last paragraph. 3. Do not use company name (EPIC), state electronic medical record system and briefly describe features related to consultation (is there an inter-team communication module within the EMR). b. Selection of Participants: i. First sentence states that an email was sent “ to all residents, fourth year medical students…and consultants.” Does “consultants” here mean attending physicians or consultant services? Please remain consistent in use of word consultants across the document. A few sentences down you state that it was sent to consultees in the ED and consultants. First sentence should be consistent with latter in terms of who was surveyed. ii. Was the survey sent to all the trainees in the ED and all trainees across consultant services? What about attending physicians were they included? From table it seems they were not included. If they weren’t then this should be clarified, and WHO speficially was surveyed needs to be consistent across the entire document (from abstract all the way across the paper). iii. You mention “moonlighters” – what are these? Attendings, residents. Please clarify iv. What is total number surveyed in each group (consultants and consultee) v. The domains explored “ demographics, consultation process, method of communication and perspectives on privacy” do not necessarily align with objectives stated. Suggest aligning with each other more clearly. Results: Pager usage is reported but in setting section authors report that pagers were phased out. Please explain in background, where in the organization pagers continue to be part of communication system. Authors report that Webex is the formal process for consultation but the tables do not clearly reflect where this category is. Table 2. Shift duration when on call may be better placed in Table 1 since it is not about consultation preferences. Table 5. Most used method – shouldn't this go in the utilization table (table 4) since it is not an “opinion”. Discussion First paragraph is a good summary Second and third, fourth paragraph. It is not clear what the study findings are and what is pulled from literature. Please restate your study finding related to the focus of the paragraph before the comparative literature review to clarify what you added to the literature and how it compares to prior findings. Conclusion related AI is not supported by the study. Can be mentioned as a modality to be explored but not listed as main recommendation drawn from study findings. Reviewer #2: Dear Author, After a careful review, I would like to offer the following comments and suggestions to help improve the clarity, organization, and overall quality of the paper: 1. The methodology section should be reorganized to follow a standard and coherent structure. 2. The “Study Population” subsection should include only the eligibility criteria of participants; study tools or instruments should not be described in this section. 3. A separate and detailed description of the data collection tool should be included. 4. The data collection tool should be referred to as a “questionnaire” rather than a “survey” (as indicated in the manuscript). 5. The data collection process needs to be described more clearly, outlining the specific procedures followed. Additionally, statistical analysis should be presented in a distinct “Data Analysis” subsection. 6. In-text citations should be formatted according to the journal’s specified referencing style. 7. In discussion section, present your study’s findings explaining how your results align with or differ from existing evidence, but do so without describing other studies in detail. ********** what does this mean? ). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our Privacy Policy ..--> Reviewer #1: No Reviewer #2: Yes: Dr. Tanima AhmedDr. Tanima AhmedDr. Tanima AhmedDr. Tanima Ahmed ********** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation . NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. Attachment Submitted filename: PONE-D-25-46511 Using Instant Messaging App study.pdf pone.0347028.s003.pdf (1.1MB, pdf) PLoS One. 2026 Apr 15;21(4):e0347028. doi: 10.1371/journal.pone.0347028.r002 Author response to Decision Letter 1 Article notes Copyright and License information Collection date 2026. PMC Copyright notice 4 Feb 2026 RESPONSE TO REVIEWERS Reviewer #1 Abstract: 1. Study objective: a. the use of consultants is confusing here as you state “residents and consultants”. I suggest using it only to refer the teams being consulted and refer to the team doing the consulting as consultee. Your aim then is about how “consultants and consultees” within the ED use IMA etc Response: Thank you for this comment. We have revised the abstract to consistently use functional roles, referring to ED-based clinicians initiating consultations as “consultees” and clinicians from other services as “consultants,” and removed role-based terms (e.g., residents) from the study objective for clarity and consistency across the manuscript. b. One stated objective is to identify areas for improvement. How is the study designed to identify this? If this is not included in the survey questionnaire, then remove from objective Response: Thank you for this comment. We agree that the original wording could imply a broader exploratory aim. We have revised the study objective to explicitly reflect the questionnaire-based assessment of participants’ perceptions of current consultation tools and their perceived need for improvement, ensuring alignment between the stated objectives and the study design. 2. Methods: Need to mention that this is within an ED context. Response: Thank you for this comment. We have revised the Methods section of the abstract as well as the manuscript to explicitly state that the study was conducted within the Emergency Department consultation context. 3. Result: some key results related to perceptions are missing from here. Response: Thank you for this suggestion. We have expanded the Results section of the abstract to include key perception-related findings, including participants’ views on efficiency, legal concerns, and the perceived need to improve current consultation tools. 4. Conclusion: this needs to be supported by the study findings. Use of AI as main part of the conclusion is not supported by findings. Response: Thank you for this comment. We have revised the Conclusion to ensure that it is directly supported by the study findings. ⸻ Introduction: 1. In general it makes a good argument for increasing usage of mobile devices in health care. Since the study focuses on communication around consultation practices, the background needs a section on that specifically. What are current practices around initiating consultation request and sharing information around the consult between the consulting teams and consultants? This needs to be added, ideally in the ED context if available, given the focus of the study. Response: Thank you for this comment. We have revised the Introduction to include a focused paragraph describing current consultation communication practices within the Emergency Department context, highlighting how consultation requests are initiated and how clinical information is typically shared between teams. This addition strengthens the background and aligns it more closely with the study’s focus. 2. Authors state that whatsap has “gained widespread use in the ED” , this needs a source/reference Response: Thank you for this comment. We have added an appropriate reference to support the statement regarding the widespread use of WhatsApp in Emergency Department communication. 3. In the paragraph about AUBMC, authors state that “all ED personnel owned”. Grammar does not fit here. If this is based on a study, then state “In a study conducted at AUBMC, all personnel reported owning …” Response: Thank you for this comment. We have revised the sentence to correct the grammar and to explicitly clarify that this statement is based on a previously published study conducted at AUBMC. 4. Last paragraph related to aims, I suggest remove whatsapp to remain consistent across the article (with abstract). Response: Thank you for this comment. We have removed “WhatsApp” from the paragraph. ⸻ Methods section 1. The study design needs to be better outlined. • This is a cross sectional survey, what type of survey? • Dates conducted • Include who was surveyed Response: Thank you for this comment. We have revised the Study Design section to more clearly outline the study methodology by explicitly stating the questionnaire-based cross-sectional design, specifying the data collection period, and summarizing the participant groups surveyed. 2. Study setting: a. The paragraph relating to how you place consults is important but needs some work: i. What type of communication were pagers used for? ii. What is Webex system? I suggest use of type of communication rather than brand and some description of what that system entails (security, access etc) iii. The statement about free wifi and use of smartphone being more “convenient” sounds like it is an assumption. Suggest to just state that the institution provides free wifi. Response: Thank you for your comment. We have revised the Study Setting section to improve clarity and neutrality by specifying the role of pagers as alert-based communication tools, removing the use of brand names in favor of a generic description of an institution-approved electronic communication system, and eliminating interpretive language regarding convenience. The text now states only that the institution provides free Wi-Fi access for staff. **iv. The paragraph related to consultation process: 1. states that “if a specialist consultation is required”. EM physicians are also specialists. I suggest usage of “if a consultation from another service is required”.** Response: Thank you for your comment. We have revised the wording to specify that consultations refer to services outside the Emergency Department, aligned the description of the consultation workflow with the institutional policy. 2. The last paragraph is a good description of policy and process and clearer than the paragraph before it where it is not clear whether the ED team contacts the attending consultant or the trainee teams on the consultant service. Figure should reflect that process outlined in last paragraph. Response: Thank you for this comment. We have ensured that Figure 1 accurately reflects the consultation process as outlined in the policy paragraph. 3. Do not use company name (EPIC), state electronic medical record system and briefly describe features related to consultation (is there an inter-team communication module within the EMR). Response: Thank you for this comment. We have revised the manuscript to remove the company name and now refer generically to the electronic medical record (EMR) system when describing the formal consultation process. ⸻ b. Selection of Participants: i. First sentence states that an email was sent “ to all residents, fourth year medical students…and consultants.” Does “consultants” here mean attending physicians or consultant services? Please remain consistent in use of word consultants across the document. A few sentences down you state that it was sent to consultees in the ED and consultants. First sentence should be consistent with latter in terms of who was surveyed. ii. Was the survey sent to all the trainees in the ED and all trainees across consultant services? What about attending physicians were they included? From table it seems they were not included. If they weren’t then this should be clarified, and WHO speficially was surveyed needs to be consistent across the entire document (from abstract all the way across the paper). iii. You mention “moonlighters” – what are these? Attendings, residents. Please clarify iv. What is total number surveyed in each group (consultants and consultee) v. The domains explored “ demographics, consultation process, method of communication and perspectives on privacy” do not necessarily align with objectives stated. Suggest aligning with each other more clearly. Response: Thank you for these comments. We have revised the Selection of Participants section to ensure consistent use of terminology by clearly defining consultees as ED-based trainees and consultants as residents and fellows from consulting services. We have explicitly stated that attending physicians were not included in the survey, clarified the role of moonlighters, and specified the total number of participants in each group. In addition, we revised the description of the questionnaire domains to more closely align with the stated study objectives. ⸻ Results: Pager usage is reported but in setting section authors report that pagers were phased out. Please explain in background, where in the organization pagers continue to be part of communication system. Authors report that Webex is the formal process for consultation but the tables do not clearly reflect where this category is. Table 2. Shift duration when on call may be better placed in Table 1 since it is not about consultation preferences. Table 5. Most used method – shouldn’t this go in the utilization table (table 4) since it is not an “opinion”. Response: Thank you for these comments. We have clarified that pagers, although largely phased out, remain in limited use within certain services, which explains their continued reporting in the Results. We also clarified that the electronic medical record system is used for formal consultation orders, whereas the tables reflect communication modalities, accounting for the absence of this category in the tables. In addition, we moved “shift duration when on call” to Table 1 and relocated utilization-related variables from Table 5 to Table 4 to improve clarity and logical organization. ⸻ Discussion: First paragraph is a good summary Second and third, fourth paragraph. It is not clear what the study findings are and what is pulled from literature. Please restate your study finding related to the focus of the paragraph before the comparative literature review to clarify what you added to the literature and how it compares to prior findings. Conclusion related AI is not supported by the study. Can be mentioned as a modality to be explored but not listed as main recommendation drawn from study findings. Response: Thank you for your comments. We have revised the Discussion to clearly distinguish our study findings from prior literature by explicitly restating key results at the beginning of each paragraph before comparative discussion. In addition, we have revised the Conclusion and Discussion to frame AI-based solutions as potential future areas for exploration rather than conclusions drawn from the present findings. ⸻ Reviewer #2 1. The methodology section should be reorganized to follow a standard and coherent structure. Response: Thank you for this comment. We have reorganized the Methodology section to follow a standard and coherent structure, clearly separating the study design and setting, study population, data collection tool, data collection procedure, and data analysis. 2. The “Study Population” subsection should include only the eligibility criteria of participants; study tools or instruments should not be described in this section. Response: Thank you for this comment. We have revised the Study Population subsection to include only participant eligibility criteria and role definitions, and removed all descriptions related to the study tool and data collection procedures, which are now presented in separate subsections. 3. A separate and detailed description of the data collection tool should be included. Response: Thank you for this comment. A separate subsection describing the data collection tool has now been added, providing a clear and detailed description of the questionnaire, including its development, structure, and domains assessed. 4. The data collection tool should be referred to as a “questionnaire” rather than a “survey” (as indicated in the manuscript). Response: Thank you for this comment. We have revised the manuscript to consistently refer to the data collection tool as a “questionnaire” throughout the Methods section and the remainder of the manuscript. 5. The data collection process needs to be described more clearly, outlining the specific procedures followed. Additionally, statistical analysis should be presented in a distinct “Data Analysis” subsection. Response: Thank you for this comment. We have clarified the data collection process by presenting it in a dedicated “Data Collection Procedure” subsection that outlines the distribution method, recruitment period, and participant inclusion. In addition, we have presented all statistical methods in a distinct “Data Analysis” subsection to improve clarity and organization. 6. In-text citations should be formatted according to the journal’s specified referencing style. Response: Thank you for this comment. We have reviewed the manuscript and ensured that all in-text citations are consistently formatted according to the journal’s specified referencing style. 7. In discussion section, present your study’s findings explaining how your results align with or differ from existing evidence, but do so without describing other studies in detail. Response: Thank you for this comment. We have revised the Discussion section to more clearly foreground our study’s findings and to explain how they align with or differ from existing evidence, while limiting detailed descriptions of prior studies and keeping the literature comparison concise. Attachment Submitted filename: Response to Reviewers.docx pone.0347028.s005.docx (26KB, docx) PLoS One. doi: 10.1371/journal.pone.0347028.r003 Decision Letter 1 Li Yang Li Yang Academic Editor Find articles by Li Yang Author information Copyright and License information Roles Li Yang : Academic Editor © 2026 Li YangLi YangLi YangLi Yang This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. PMC Copyright notice 13 Mar 2026 Dear Dr. Mufarrij, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Apr 27 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at [email protected] . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. A letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .... We look forward to receiving your revised manuscript. Kind regards, Li V. Yang, Ph.D. Academic Editor PLOS One Journal Requirements: 1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed ********** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes ********** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.--> Reviewer #1: Yes ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ********** Reviewer #1: Thank you for addressing all the comments. A few additional comments to improve the article: In the section on study design: 1. The second sentence is redundant and can be removed. “This is a cross-sectional study conducted at ..” 2. In the methods section that describes the consulting process, the authors mention that and order is placed followed by the ED team contacting the consultant team. What is the goal of this second contact? Is this where patient information is shared and the question to the consultant is outlined? Or is that done through the order? Please clarify.. Table 2: What does use of one’s smartphone by someone else mean? ********** what does this mean? ). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our Privacy Policy ..--> Reviewer #1: No ********** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation . NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. PLoS One. 2026 Apr 15;21(4):e0347028. doi: 10.1371/journal.pone.0347028.r004 Author response to Decision Letter 2 Article notes Copyright and License information Collection date 2026. PMC Copyright notice 18 Mar 2026 1. The second sentence is redundant and can be removed. “This is a cross-sectional study conducted at ..” Thank you for the comment. The sentence has been removed and the paragraph was revised to improve clarity and conciseness. 2. In the methods section that describes the consulting process, the authors mention that and order is placed followed by the ED team contacting the consultant team. What is the goal of this second contact? Is this where patient information is shared and the question to the consultant is outlined? Or is that done through the order? Please clarify.. Thank you for the comment. We revised the Methods section to clarify the consultation workflow. Specifically, we clarified that a consultation order is placed in the EMR for documentation and tracking purposes but does not generate an automatic notification to the consulting team. The ED team subsequently contacts the on-call consultant directly using any method of the ones mentioned in the manuscript to communicate patient information and the clinical question. Table 2 What does use of one’s smartphone by someone else mean? Thank you for the comment. We clarified the wording of this variable in Table 2. It refers to situations in which another team member uses the participant’s smartphone to communicate with consulting services during clinical duties. Attachment Submitted filename: Response_to_Reviewers_auresp_2.docx pone.0347028.s006.docx (18.8KB, docx) PLoS One. doi: 10.1371/journal.pone.0347028.r005 Decision Letter 2 Li Yang Li Yang Academic Editor Find articles by Li Yang Author information Copyright and License information Roles Li Yang : Academic Editor © 2026 Li YangLi YangLi YangLi Yang This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. PMC Copyright notice 26 Mar 2026 Using Instant Messaging Applications for Consultations in the Emergency Department: A cross-sectional survey PONE-D-25-46511R2 Dear Dr. Mufarrij, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact  and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact  and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact  and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support .... If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact [email protected]. Kind regards, Li V. Yang, Ph.D. Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: PLoS One. doi: 10.1371/journal.pone.0347028.r006 Acceptance letter Li Yang Li Yang Academic Editor Find articles by Li Yang Author information Copyright and License information Roles Li Yang : Academic Editor © 2026 Li YangLi YangLi YangLi Yang This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. PMC Copyright notice PONE-D-25-46511R2 PLOS One Dear Dr. Mufarrij, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact [email protected]. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing . If we can help with anything else, please email us at [email protected]. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Li V. Yang Academic Editor PLOS One Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Supplementary Materials S1 File. Study questionnaire. Full survey instruments used for consultants and consultees assessing consultation practices and use of instant messaging applications in the emergency department. (DOCX) pone.0347028.s001.docx (67.2KB, docx) S2 File. Inclusivity in global research. Completed PLOS checklist detailing ethical, cultural, and authorship considerations for research conducted at AUBMC. (DOCX) pone.0347028.s002.docx (67.9KB, docx) Attachment Submitted filename: PONE-D-25-46511 Using Instant Messaging App study.pdf pone.0347028.s003.pdf (1.1MB, pdf) Attachment Submitted filename: Response to Reviewers.docx pone.0347028.s005.docx (26KB, docx) Attachment Submitted filename: Response_to_Reviewers_auresp_2.docx pone.0347028.s006.docx (18.8KB, docx) Data Availability Statement The data underlying this study contain potentially identifiable clinical information and cannot be shared publicly due to institutional and ethical restrictions imposed by the American University of Beirut Medical Center (AUBMC) and its Institutional Review Board. Data access may be requested through the AUB Human Research Protection Program (HRPP) / Institutional Review Board at [email protected] . Requests will be evaluated in accordance with AUB’s data protection and ethical oversight policies. The dataset used in this study is stored securely within the Department of Emergency Medicine at AUBMC. Articles from PLOS One are provided here courtesy of PLOS ACTIONS View on publisher site PDF (406.8 KB) Cite Collections Permalink PERMALINK Copy RESOURCES Similar articles Cited by other articles Links to NCBI Databases Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM Add to Collections Create a new collection Add to an existing collection Name your collection * Choose a collection Unable to load your collection due to an error Please try again Add Cancel Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top

Related documents

• Reduced susceptibility to triclosan and proposed epidemiological cut-off values for disinfectants and heavy metals in Escherichia coli isolated from Thai tilapia farms: Implications for One Health antimicrobial resistance surveillance.#1039988
• Edible coatings and films in meat preservation: Materials, functional mechanisms, and technological challenges.#1039989
• Palm Vein Biometrics A Rapid Patient Identification Tool for Emergency and Trauma Care.#1039990
• Directions for Establishing a Korean National One Health Joint Plan of Action: Focusing on Zoonotic Disease Preparedness and Response.#1039991
• Intensive arable farming calls for resilient wild bee restoration amid severe abundance fluctuations.#1039992