Best Practices for Reducing Notification Fatigue


Best Practices for Reducing Notification Fatigue

Part I of a series, June 2016  

During the Connexall implementation process, your Connexall deployment team meets with your clinical leadership to discuss selection of events for notification, routing of those notifications, and timing and routing for escalation.  During that process we share our experiences gained, and best practices observed, serving over a thousand healthcare providers. 
This series of best practice communications seeks to equip you to update your alarm management workflows with our continuous improvements and ongoing learnings.

Use of the Connexall suspend feature to mitigate notification fatigue 

Unique in the industry, Connexall’s suspend feature allows you to establish a configurable delay in dispatch of notification of selected alarms. 
For instance, we have observed that SpO2 Low and Desaturation alarms can account for tens of thousands of alarms on a single unit.  Of these alarms, thousands will self-correct within a matter of seconds.  By implementing a short delay before forwarding those alarms to a caregiver’s mobile device we can reduce the total number of notifications, and therefore alarm fatigue substantially. 
At a west coast academic medical institution, on a unit where 62,295 SpO2 Low alarms were generated in one month, implementing a 25 second suspend in Connexall in addition to the 5 second built in monitor delay had the ability to reduce the number of alarms delivered to mobile device to only 16,205.  A 74% reduction in notifications tied just to this one alarm! 
This logic has also been applied to other alarms such as High HR and Leads Off, utilizing reporting to validate decisions, to decrease the instance of nuisance alarms by similar margins.  Maria Cvach, et. al., at Johns Hopkins writing in the Journal of Nursing Care Quality (August, 2013) described the use of a 60 second suspend time for all non-crisis alarms, and the substantial reduction of notifications being routed to mobile caregivers. 

See the article here:
 
Use of pagers with an alarm escalation system to reduce cardiac monitor alarm signals 






Part II of a series, September 2016

This is a continuation of our Best Practice series aiming to communicate experiences gained while serving our customers in over a thousand facilities worldwide. Part I of this series reviewed utilization of our unique suspend feature in alarm routing to mitigate notification fatigue. This installment seeks to review Connexall’s patented Count Trigger as a means of further alleviating notification fatigue in conjunction with suspend.

Use of Connexall’s patented Count Trigger as adjunct to suspend to mitigate notification fatigue

A review from Part I: The suspend feature, a configurable delay in dispatch of notification, allows a patient event to self-correct prior to delivering a message to the end device. For instance, if a patient breaks through his set heartrate parameter, the alarm will sound at the bedside or central monitor, it will deliver to Connexall and be available for reporting purposes, but Connexall holds the alarm for a user-configurable number of seconds before dispatching the alert to the appropriate caregiver. This allows the patient to return within parameters and decreases the volume of notifications to the caregiver.

With this feature, how do we protect the safety of the patient who is repeatedly breaking through parameters for very short periods of time?

Connexall’s patented Count Trigger logic allows you to set an algorithm to dispatch a notification if the patient triggers an event X number of times in X seconds or minutes, decreasing the risk of a missed event. For instance, if a patient repeatedly alarms Heartrate High for less than 5 seconds 6 times in 2 minutes, Connexall will dispatch a unique notification to the assigned care provider “Heartrate High Count Trigger Room ___” providing a notable indication that the patient had a repeated event.

Visible Notification Reduction
6 Monitor Alarms = 1 Notification
Room 1402 HR High 107>100 Time: 07:15:02
Duration: 4 seconds
HR High Count Trigger Room 1402
Time: 07:16:33
Room 1402 HR High 110>100 Time: 07:15:25
Duration: 4 seconds
Room 1402 HR High 109>100 Time: 07:15:40
Duration: 3 seconds
Room 1402 HR High 111>100 Time: 07:16:04
Duration: 4 seconds
Room 1402 HR High 107>100 Time: 07:16:20
Duration: 2 seconds
Room 1402 HR High 107>100 Time: 07:16:33
Duration: 2 seconds


Connexall customers currently most often apply Count Trigger logic alongside suspend timing for heartrate and desaturation alarms. Application of Count Trigger in conjunction with the suspend feature assists in mitigating notification fatigue and protects patient safety by bringing awareness to a potential event.


Call to Action

Please share these communications among your clinical and biomedical colleagues.  If you would like to understand how you can mitigate, indeed reduce, notification fatigue please contact us at This email address is being protected from spambots. You need JavaScript enabled to view it..  We would be pleased to schedule a call and discuss the best practices we have learned over more than 20 years of operation.