Communication Latencies of Wireless Devices Suitable for Time-Critical Messaging to Anesthesia Providers

Abstract

Rapid and reliable methods of text communication to mobile anesthesia care providers are important to patient care and to efficient operating room management. Anesthesia departments are implementing automated methods to send text messages to mobile devices for abnormal vital signs, clinical recommendations, quality of care, and compliance or billing issues. The most time-critical communications determine maximum acceptable latencies. We studied the reliability of several alphanumeric messaging systems to identify an appropriate technology for such use. Latencies between message initiation and delivery to 3 alphanumeric paging devices were measured over weeks. Two devices used Internet pathways outside the hospital's local network with an external paging vendor (SkyTel). The third device used only the internal hospital network (Zetron). Sequential cell phone text page latencies were examined for lag-1 autocorrelation using the runs test, with results binned by hour and by day. Message latencies subsequently were batched in successive 1-week bins for calculation of the mean and 99th percentiles of latencies. We defined acceptance criteria as a mean latency <30 seconds and no more than 1 in 200 pages (0.5%) having a latency longer than 100 seconds. Cell phone texting was used as a positive control to assure that the analysis was appropriate, because such devices have (known) poor reliability during high network activity. There was substantial correlation among latencies for sequential cell phone text messages when binned by hours (P < 0.0001), but not by days (P = 0.61). The 2 devices using Internet pathways outside the hospital's network demonstrated unacceptable performance, with 1.3% and 33% of latencies exceeding 100 seconds, respectively. The device dependent only on the internal network had a mean latency of 8 seconds, with 100% of 40,200 pages having latencies <100 seconds. The findings suggest that the network used was the deciding factor. Developers of anesthesia communication systems need to measure latencies of proposed communication pathways and devices used to deliver urgent messages to mobile users. Similar evaluation is relevant for text pagers used on an ad hoc basis for delivery of time-critical notifications. Testing over a period of hours to days is adequate only for disqualification of a candidate paging system, because acceptable results are not necessarily indicative of long-term performance. Rather, weeks of testing are required, with appropriate batching of pages for analysis.