Last winter I got into it with a consulting company’s clinical leader about the difference between alarms and alerts. Over the years I’d come to believe that nurse calls were, in many respects, no different than phone calls or alarms from a patient monitor. Consultants, vendors, and hospital customers often get hung up on the difference between “messaging,” “alarms,” “notifications,” or “alerts.” Then throw in the differences between ringtones, vibrations, popups, flashing lights, or tones of any kind. Whether from man or machine (computer, smartphone, beeper, nurse call, patient monitor, tablet, etc..) these sensory bursts are conveyors of status changes, new details, signposts that there is something to be communicated, sometimes unnecessarily. Each message has varying degrees of criticality, running the spectrum of trivial to life or death. In the cacophony of a nursing unit of any hospital on any day, it’s all noise—and it’s hard to figure out what’s important.
As we finish up the second decade of the 21st Century, we are being crippled under the weight of these messaging streams, and it is dangerous. Whether it’s my 82-year-old mother who has thousands of unread messages and notifications on her phone and doesn’t know how to deal with them or a community hospital’s nursing supervisor who is deluged with escalated messages from nursing units and is simply unable to respond because of capacity or a faulty, unreviewed workflow...be it personally or professionally, few people have the tools, the discipline, the constitution, or the training to effectively manage these streams.
And while we might be tolerant or amused by the “continuous state of half attention” at dinner tables or watching the football game on Sunday, as we indulgently stare at our phones clamoring for likes on Facebook, Snapchat or Instagram, this “half attention” is not defensible for anyone involved with activity that can impact the life or safety of others—be it a long haul trucker, pilot, doctor or nurse. I’m not suggesting that professionals are paying too much attention to their Twitter feeds in the workplace (and yes that goes on), but that it’s all part of a bigger wash. All of this is distracting. It adds up. And we are all distracted.
I think we all know that a messaging deluge is occurring. How much of it is going on, the impact it creates, and the tools/techniques for taming it is an essential area that we, as technologists, owe to our customers to develop, share, and collaborate on.
Here are 10 suggestions that your organization can do now to minimize distraction:
- Consider broadening existing cross-disciplinary alarm committee initiatives to include notification/messaging and interruptions.
- Analyze and review workflows that include notification. Prioritize and eliminate when possible.
- Establish notification/alarm threshold KPIs and revisit 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 and encourage them to report excess and inefficiency.
- 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.
- When possible, modify/tweak source system thresholds to optimize event and notification rules.
Kenny Schiff is the Founder and CEO of CareSight. A 20-year veteran of the healthcare technology business, Kenny is considered by his customers and peers to be a no-nonsense, trusted resource who can be counted on to deliver complex solutions with high impact. His team pioneered managed services to clinical communications customers starting in 2003. Visionary always, but never afraid to be hands-on, CareSight is a great creative platform for Kenny’s entrepreneurial and technical passions.
