Quick Summary
Caregivers are overwhelmed by a critical mass of notifications, alarms, and alerts day-to-day, only some of which are necessary. Common mobile distractors for patient-related caregivers include everything from nurse call alerts to pagers and voicemails.
Interruptions can negatively impact patient care, especially when it comes to medication errors. These mistakes are also costly for the hospital system. This is especially true in cases of alarm fatigue associated with the overuse of bed exit alarms.
Using data-driven messaging analytics organizations can tweak the circumstances under which staff receive alerts, thus reducing the mental load on caregivers and improving patient care.
Over the last decades, communication mobility has become a critical component of modern healthcare operations. Pagers, in-building telephone systems, and smartphones have revolutionized hospital workflow and communications, in ways both positive and negative.
These platforms provide essential connectivity to caregivers. However, they also produce an endless stream of controlled and uncontrolled interruptions that can keep nurses and clinical/operational staff from providing optimal care.
The first phase of the communication evolution in healthcare has focused primarily on increasing connectivity. We, need to find ways to organize and quiet the cacophony of messaging across uncoordinated or related platforms, without reducing effectiveness.
Lone Star Communications' data-driven messaging analytics can provide key guidance to health systems as they look to find the “sweet spot” that allows the right people to get the right messages, at the right time for the right reasons.
Defining Terms
For our purposes, we are considering all types of messaging and notifications, including alarms, alerts, ringtones, vibrations, and voicemails.
Examples of common mobile distractors for patient-related roles include:
Nurse call alerts
Vocera calls
Phone calls
Pager notifications
Text messages
Phone calls
Email
Not All Alerts Are Created Equal
As hospitals struggle to assess and manage patient-related notifications, it’s important to keep in mind that not all alerts and notifications are equally important or urgent.
Consider these five alerts regarding patient care, progressing from least to most urgent:
Needs help finding glasses
Request for water
Reporting an increase in pain
Having difficulty breathing
Cardiac arrest
The first step toward effectively managing notifications is to recognize that some alerts are more pressing than others. Consider grouping common requests and alerts by severity to help staff prioritize patient care.
The Effects of Interruptions
Caregivers experience alerts and alarms as interruptions. Research confirms that interruptions at high working memory load are associated with decreased task performance. Interrupted tasks are more likely to be:
Forgotten
Rushed
Partially completed
Repeated
Additionally, studies have shown:
1. Interruptions that are particularly similar to the primary task are more likely to disrupt task performance
Example: A nurse completing documents for Patient A is interrupted to complete the same document for Patient B. Consequently, Patient A’s document may be affected by Patient B’s information.
2. Interruptions during cognitive tasks are more disruptive than those experienced in-between tasks
Example: A nurse chooses to complete administering medications to a patient before responding to an inquiry about discharge arrangements for another patient.
3. Interruptions with different modalities from the primary task reduce disruption
Example: A doctor may easily deal with a phone call while undertaking a visually-oriented primary task, such as an X-ray examination. However, an interruption involving an electronic ordering task could potentially lead to errors in interpreting the X-ray.
Interruptions Are Dangerous and Costly
Unfortunately, interrupted tasks can negatively impact patient care and the hospital’s bottom line.
A recent study of Australian Hospitals found that interruptions negatively affected medication administration. Each interruption increased the nurse’s risk of making a medication error by 12.7%, and nurses were three times more likely to make medication errors when they experienced six interruptions.
Another study estimated that each operational failure that resulted in an interruption ended up costing the hospital a median of $117, or roughly $95 per hour, per nurse.
Minimizing distractions is imperative for the success of caregivers and the well-being of patients.
Alarm Fatigue: A Real Threat to Patient Care
Alarm fatigue occurs when a caregiver’s senses are overloaded due to exposure to an excessive number of alerts or notifications. Alarm fatigue may result in desensitization to alarms and, consequently, missed alarms.
Notably, up to 99% of alarms are falsely activated; related to human, organizational, or tech factors, and do not require clinical intervention according to a 2022 study published in SAGE Open Nursing.
A 2011 survey by the Healthcare Technology Foundation polled 4,000 clinicians in acute care hospitals, and found that:
76% of respondents reported that nuisance alarms occur frequently
71% of respondents found that nuisance alarms disrupted patient care
78% of caregivers felt that nuisance alarms reduced trust in alarms, and led to caregivers inappropriately turning off alarms at times other than setup or procedural events
Up to 65% of caregivers confirmed that when multiple devices are used with a single patient, it can be difficult to determine which device is sounding an alarm
78% of respondents believed that smart alarms would be effective at reducing false alarms and improving clinical response
Increasingly, bed exit notifications contribute to alarm fatigue, as these alerts occur automatically when a patient moves, and at all hours of the day and night.
Because falls are so detrimental to patients and costly for hospitals, bed exit alarms have become ubiquitous in healthcare settings. While these alerts are sometimes useful for caregivers, overuse of bed exit notifications may inadvertently negatively impact patient care. It’s important to keep in mind that bed exit notifications can be a disruption to the patient, other patients, and caregivers.
Finding the Notification Sweet Spot
Data-driven messaging analytics empowers organizations to look at their staff’s messaging load as it relates to the roles of the individuals in the organization and assess notifications by urgency and time of day. Using data-driven analytics, team leaders are able to ask:
Do I have the opportunity to lower those notification levels for staff?
What can I do to improve my patient care?
How can this impact patient satisfaction?
How can I improve staff satisfaction?
According to the SAGE Open Nursing study, an alarm management strategy can save an organization hundreds of thousands of dollars.
Let’s look at some real bed exit notification analytics as an example.
Our example hospital, in October of 2017, had 148 unique beds or chairs that sent notifications to 159 unique nurses and 85 unique personal care assistants (PCA).
During the month of October, this hospital had 6,458 bed exit alerts for 148 beds. There were 28,707 unique messages that went to staff. That means that for every bed exit, there were 4.4 notifications.
Looking at the data in greater detail, we find that:
20% of bed exit alarms were resolved within three seconds with no intervention
15.5% of bed exit alarms were canceled within two seconds
Given this information, management may propose implementing a two-second delay in bed exit notification. Doing so would:
Reduce the number of alarms by 5,973 a month (193/day)
Reduce the number of actionable alarm events to 4,417 (from 6,458)
By tweaking the conditions under which caregivers receive notifications, the hospital can lighten the load of their teams, and free up more time for patient care.
This is just one example of the ways that healthcare organizations can leverage data to implement change, support staff and protect patients.
Top 10 Tips To ‘Tame the Beast’
Here are ten things that your organization can do right now to help preclude alarm fatigue and minimize unnecessary alarms and distractions:
Consider broadening existing cross-disciplinary alarm committee initiatives to include notification/messaging and interruptions
Analyze and review workflows that include notifications; prioritize and eliminate when possible
Establish notification/alarm threshold key performance indicators (KPI) and revisit them regularly to ensure compliance
Use native and third-party analytics to audit message streams and look at the correlation between staffing levels, patient census, and time of day — data can show you where to optimize
Model suspend or delay scenarios to factor in self-correction and false alarms/notifications
Educate staff about notification/alert management techniques
Survey staff regarding messaging, notifications, and alarm fatigue; encourage staff to report excesses and inefficiencies
Observe staff in context, including patient care areas to validate issues, behaviors, and areas for improvement
Create no-interruption zones, especially for sensitive activities that require precision
Modify/tweak source system thresholds when possible to optimize event and notification rules
Final Thoughts
Caregivers are navigating a deluge of messaging every day and night on the job. As technologists, we owe it to our customers to continue exploring tools and techniques for organizing the onslaught of information, for example, involving all of your key health care stakeholders in your communications plan.
We don’t need more messages — we need better messages, smarter messages, and, in many cases, fewer messages.
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Jeff Richard is the Chief Technology Officer at Lone Star Communications, and a thought leader on best practices when working with stakeholders through complex healthcare implementation and digital transformation projects.