title: Communication latencies of Apple push notification messages relevant for delivery of time-critical information to anesthesia providers.
abstract: BACKGROUND
  Tablet computers and smart phones have gained popularity in anesthesia departments for educational and patient care purposes. VigiVU(™) is an iOS application developed at Vanderbilt University for remote viewing of perioperative information, including text message notifications delivered via the Apple Push Notification (APN) service. In this study, we assessed the reliability of the APN service.
  
  
  METHODS
  Custom software was written to send a message every minute to iOS devices (iPad(®), iPod Touch(®), and iPhone(®)) via wireless local area network (WLAN) and cellular pathways 24 hours a day over a 4-month period. Transmission and receipt times were recorded and batched by days, with latencies calculated as their differences. The mean, SEM, and the exact 95% upper confidence limits for the percent of days with ≥1 prolonged (>100 seconds) latency were calculated. Acceptable performance was defined as mean latency <30 seconds and ≤0.5% of latencies >100 seconds. Testing conditions included fixed locations of devices in high signal strength locations.
  
  
  RESULTS
  Mean latencies were <1 second for iPad and iPod devices (WLAN), and <4 seconds for iPhone (cellular). Among >173,000 iPad and iPod latencies, none were >100 seconds. For iPhone latencies, 0.03% ± 0.01% were >100 seconds. The 95% upper confidence limits of days with ≥1 prolonged latency were 42% (iPhone) and 5% to 8% (iPad, iPod).
  
  
  CONCLUSIONS
  The APN service was reliable for all studied devices over WLAN and cellular pathways, and performance was better than third party paging systems using Internet connections previously investigated using the same criteria. However, since our study was a best-case assessment, testing is required at individual sites considering use of this technology for critical messaging. Furthermore, since the APN service may fail due to Internet or service provider disruptions, a backup paging system is recommended if the APN service were to be used for critical messaging.
authors.affiliation: Division of Multispecialty Adult Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Rothman
authors.forename: Franklin
authors.initials: F
authors.lastname: Dexter
authors.forename: Richard H
authors.initials: RH
authors.lastname: Epstein
mesh_terms: D000761:Anesthesia Department, Hospital; D000773:Anesthesia, Obstetrical; D040421:Cell Phone; D003195:Computer Communication Networks / Q000295:instrumentation*; D034201:Computers, Handheld; D005260:Female; D006751:Hospital Information Systems; D006801:Humans; D033183:Interdisciplinary Communication; D007743:Labor, Obstetric; D010348:Patient Care Team; D011247:Pregnancy; D012985:Software Design; D060145:Text Messaging; D013997:Time Factors; D014584:User-Computer Interface; D014741:Video Recording