Characterizing Push Notification Volume and Delivery Patterns in Hospital Medicine

Background: Push notifications are a common method of clinical communication in inpatient settings, yet their volume and delivery patterns have not been described. Alert fatigue has been well described in healthcare, and push notifications may be a new contributor. Objective: To characterize the volume, type, and temporal distribution of push notifications received by hospitalists across distinct clinical roles in a large academic health system. Methods: We conducted a cross-sectional analysis of electronic health record (EHR) audit log data from June 1, 2024, to June 1, 2025, at a large academic health system using Epic (Verona, WI) EHR. All push notifications received by attending hospitalists were extracted, categorized (secure message, results, other), and summarized by hour, hospitalist role, and device type. Results: Ninety-seven hospitalists received 1,114,657 push notifications over one year, with a median of 11 (3-24) notifications per hour. Rounding hospitalists received 9 (7-12) notifications per patient per working day. Secure message notifications accounted for the majority and result-related notifications comprised only 2.2% of notifications. Notifications peaked midday and were received throughout the day, including outside of scheduled shift times. Conclusions: Hospitalists are exposed to a high volume of push notifications, which may contribute to alert fatigue and ultimately impact patient safety and clinician wellbeing. System-level efforts to prioritize clinically meaningful notifications, refine notification settings, and enhance secure-messaging infrastructure are needed to protect clinician attention and support patient safety.