title: Testing modes of computerized sepsis alert notification delivery systems.
abstract: The 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.
  
  
  
  We 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.
  
  
  
  Twenty 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.
  
  
  
  Technical 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.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: Mikhail A
authors.initials: MA
authors.lastname: Dziadzko
authors.affiliation: Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Harrison
authors.affiliation: Department of Information Technology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Ing C
authors.initials: IC
authors.lastname: Tiong
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pickering
authors.affiliation: Division of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Pablo
authors.initials: P
authors.lastname: Moreno Franco
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. herasevich.vitaly@mayo.edu.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Herasevich
mesh_terms: D034201:Computers, Handheld; D020000:Decision Support Systems, Clinical / Q000592:standards*; D057286:Electronic Health Records / Q000592:standards*; D006751:Hospital Information Systems / Q000592:standards*; D006801:Humans; D018805:Sepsis; D000068997:Smartphone
keywords: Alert fatigue; Decision support system; Methods of alert delivery; Notification; Sepsis