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Testing modes of computerized sepsis alert notification delivery systems.

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Pagers provided faster urgent alert acknowledgment than electronic health record (EHR) notifications in the intensive care unit (ICU). Smartphone alerting faced technical failures, hindering comparisons of this modern technology for critical care notifications.

Keywords:
Alert fatigueDecision support systemMethods of alert deliveryNotificationSepsis

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Area of Science:

  • Critical Care Medicine
  • Health Informatics
  • Clinical Alerting Systems

Background:

  • Electronic health record (EHR)-based notifications are increasingly used for urgent and emergent alerts.
  • Paging remains a common method for urgent alert delivery, despite the prevalence of smartphones.
  • Secure smartphone alerting for clinical notifications is an emerging area.

Purpose of the Study:

  • To compare the efficacy of pagers, EHR notifications, and smartphones for urgent alert delivery in the intensive care unit (ICU).
  • To evaluate time to notification acknowledgment, clinician fatigue, and user preferences for different alert delivery methods.

Main Methods:

  • Randomized sepsis alerts were delivered to ICU clinicians via pager, EHR notification, or personal smartphone/tablet.
  • Key metrics included time to alert acknowledgment, fatigue levels, and user preferences via survey.
  • The study involved 23 clinicians over 3 months, generating 48 alerts for 46 patients.

Main Results:

  • While all alerts were acknowledged, technical failures in the smartphone/tablet arm confounded primary outcome analysis.
  • Median acknowledgment time was significantly shorter for pagers (102 minutes) compared to EHR notifications (169 minutes).
  • No significant differences were found in secondary outcomes, including fatigue measurements and user preferences.

Conclusions:

  • Technical failures in smartphone/tablet alert delivery pose a barrier to evaluating modern technology for urgent ICU alerts.
  • Fatigue and user preference data were similar across all alert delivery methods studied.
  • Further research is needed to overcome human and technical barriers for implementing modern alerting technologies in hospitals.