Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
BMC Health Serv Res. 2013 Aug 5;13:295. doi: 10.1186/1472-6963-13-295.
Health care providers play a significant role in large scale health emergency planning, detection, response, recovery and communication with the public. The effectiveness of health care providers in emergency preparedness and response roles depends, in part, on public health agencies communicating information in a way that maximizes the likelihood that the message is delivered, received, deemed credible and, when appropriate, acted on. However, during an emergency, health care providers can become inundated with alerts and advisories through numerous national, state, local and professional communication channels. We conducted an alert fatigue study as a sub-study of a larger randomized controlled trial which aimed to identify the most effective methods of communicating public health messages between public health agencies and providers. We report an analysis of the effects of public health message volume/frequency on recall of specific message content and effect of rate of message communications on health care provider alert fatigue.
Health care providers enrolled in the larger study (n=528) were randomized to receive public health messages via email, fax, short message service (SMS or cell phone text messaging) or to a control group that did not receive messages. For 12 months, study messages based on real events of public health significance were sent quarterly with follow-up telephone interviews regarding message receipt and topic recall conducted 5-10 days after the message delivery date. During a pandemic when numerous messages are sent, alert fatigue may impact ability to recall whether a specific message has been received due to the "noise" created by the higher number of messages. To determine the impact of "noise" when study messages were sent, we compared health care provider recall of the study message topic to the number of local public health messages sent to health care providers.
We calculated the mean number of messages that each provider received from local public health during the time period around each study message and provider recall of study message content. We found that recall rates were inversely proportional to the mean number of messages received per week: Every increase of one local public health message per week resulted in a statistically significant 41.2% decrease (p < 0.01), 95% CI [0.39, .87] in the odds of recalling the content of the study message.
To our knowledge, this is the first study to document the effects of alert fatigue on health care providers' recall of information. Our results suggest that information delivered too frequently and/or repetitively through numerous communication channels may have a negative effect on the ability of health care providers to effectively recall emergency information. Keeping health care providers and other first-line responders informed during an emergency is critical. Better coordination between organizations disseminating alerts, advisories and other messages may improve the ability of health care providers to recall public health emergency messages, potentially impacting effective response to public health emergency messages.
医疗保健提供者在大规模卫生应急规划、检测、应对、恢复和与公众沟通方面发挥着重要作用。医疗保健提供者在应急准备和应对角色中的有效性部分取决于公共卫生机构以最大限度地提高信息传递、接收、被认为可信的可能性，并在适当情况下采取行动的方式来传达信息。然而，在紧急情况下，医疗保健提供者可能会通过众多国家、州、地方和专业沟通渠道收到大量警报和咨询。我们进行了一项警报疲劳研究，作为一项旨在确定在公共卫生机构和提供者之间传达公共卫生信息的最有效方法的更大规模随机对照试验的子研究。我们报告了公共卫生信息数量/频率对特定信息内容的回忆效果以及信息通信率对医疗保健提供者警报疲劳的影响的分析。
参加较大研究的医疗保健提供者（n=528）被随机分配通过电子邮件、传真、短信服务（SMS 或手机短信）或不接收消息的对照组接收公共卫生消息。在 12 个月的时间里，基于具有公共卫生重要意义的真实事件的研究消息每季度发送一次，并在消息发送日期后的 5-10 天进行有关消息接收和主题回忆的后续电话访谈。在大流行期间，由于发送了大量消息，警报疲劳可能会影响对特定消息是否已收到的回忆能力，因为“噪音”会导致消息数量增加。为了确定在发送研究消息时“噪音”的影响，我们将医疗保健提供者对研究消息主题的回忆与发送给医疗保健提供者的当地公共卫生消息数量进行了比较。
我们计算了每个提供者在研究消息前后的时间段内从当地公共卫生部门收到的消息的平均数量以及提供者对研究消息内容的回忆。我们发现，回忆率与每周收到的消息数量成反比：每周多收到一条当地公共卫生消息，就会导致研究消息内容的回忆几率统计学显著降低 41.2%（p<0.01），95%CI[0.39，0.87]。
据我们所知，这是第一项记录警报疲劳对医疗保健提供者信息回忆影响的研究。我们的结果表明，通过多个沟通渠道过于频繁和/或重复地传递信息可能会对医疗保健提供者有效回忆紧急信息的能力产生负面影响。在紧急情况下让医疗保健提供者和其他一线响应人员了解情况至关重要。更好地协调发布警报、咨询和其他消息的组织可能会提高医疗保健提供者回忆公共卫生应急消息的能力，从而可能影响对公共卫生应急消息的有效响应。
