Abstract
BackgroundThe number of electronic health record (EHR)-based notifications continues to rise. One common method to deliver urgent and emergent notifications (alerts) is paging. Despite of wide presence of smartphones, the use of these devices for secure alerting remains a relatively new phenomenon.MethodsWe compared three methods of alert delivery (pagers, EHR-based notifications, and smartphones) to determine the best method of urgent alerting in the intensive care unit (ICU) setting. ICU clinicians received randomized automated sepsis alerts: pager, EHR-based notification, or a personal smartphone/tablet device. Time to notification acknowledgement, fatigue measurement, and user preferences (structured survey) were studied.ResultsTwenty three clinicians participated over the course of 3 months. A total of 48 randomized sepsis alerts were generated for 46 unique patients. Although all alerts were acknowledged, the primary outcome was confounded by technical failure of alert delivery in the smartphone/tablet arm. Median time to acknowledgment of urgent alerts was shorter by pager (102 mins) than EHR (169 mins). Secondary outcomes of fatigue measurement and user preference did not demonstrate significant differences between these notification delivery study arms.ConclusionsTechnical failure of secure smartphone/tablet alert delivery presents a barrier to testing the optimal method of urgent alert delivery in the ICU setting. Results from fatigue evaluation and user preferences for alert delivery methods were similar in all arms. Further investigation is thus necessary to understand human and technical barriers to implementation of commonplace modern technology in the hospital setting.
Highlights
The number of electronic health record (EHR)-based notifications continues to rise
The objective of this study was to compare three methods of alert delivery - pagers, EMR-based notifications, and smartphones - to determine the best method of urgent alerting in the intensive care unit (ICU) setting
Only 46 patients were “claimed”, and a total of 48 alerts were sent by the randomization algorithm (Table 1)
Summary
The number of electronic health record (EHR)-based notifications continues to rise. One common method to deliver urgent and emergent notifications (alerts) is paging. Generation of computerized notifications and alarms by automated detection algorithms for a variety of clinical conditions leads to alarm fatigue, which is one of the most important health technology hazards over past years [1]. Perception of different methods of alert delivery is significantly influenced by complex human cognition factors [5, 6]. In the specific context of the hospital setting, mechanisms of notification or alert delivery have been exploited, including oral communication, charts, loudspeaker alerts, phones, paging, electronic health record (EHR) display, and email [7]. New methods of alert delivery have led to the development of technology to reduce errors in the hospital setting [8]
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