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

Sarah S. Abdul-Nabi; Souraya Arabi; Hind Anan; Hussein Hijazi; Hani Tamim; Jean-Marie Al Semaani; Maha Makki; Afif Mufarrij

doi:10.1371/journal.pone.0347028

Peer Review History

Original SubmissionSeptember 3, 2025
12 Dec 2025 Decision Letter - Li Yang, Editor 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 plosone@plos.org. 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. 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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. 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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. Attachments Attachment Submitted filename: PONE-D-25-46511 Using Instant Messaging App study.pdf https://doi.org/10.1371/journal.pone.0347028.r001
Revision 1
4 Feb 2026 Author Response 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. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0347028.r002
13 Mar 2026 Decision Letter - Li Yang, Editor 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 plosone@plos.org. 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. https://doi.org/10.1371/journal.pone.0347028.r003
Revision 2
18 Mar 2026 Author Response 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. Attachments Attachment Submitted filename: Response_to_Reviewers_auresp_2.docx https://doi.org/10.1371/journal.pone.0347028.r004
26 Mar 2026 Decision Letter - Li Yang, Editor 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 onepress@plos.org. Kind regards, Li V. Yang, Ph.D. Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0347028.r005
Formally Accepted
Acceptance Letter - Li Yang, Editor 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 onepress@plos.org. 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 customercare@plos.org. 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 https://doi.org/10.1371/journal.pone.0347028.r006

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